John R Dodge, DMD,MS Valid NPI

Individual provider · Periodontics · Boulder, CO

NPI

1629190194

Type

Individual (Type 1)

Primary specialty

Periodontics (Dentist)

Specialty group

Dental Providers

Taxonomy code

1223P0300X

License number

CO7489 (CO)

Sex

Male

Sole proprietor

No

Enumerated

2007-04-04

Last updated

2007-07-08