Individual
DONALD DODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
492 OLD TOWN RD, PORT JEFFERSON STATION, NY 11776-2249
(631) 928-1018
Mailing address
14 BUNNY LN, EAST SETAUKET, NY 11733-3504
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
039774-1
NY
Other
Enumeration date
03/12/2007
Last updated
07/08/2007
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