Individual
DR. CHARLES G BODE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
5750 W THUNDERBIRD RD, H-850, GLENDALE, AZ 85306-4660
(602) 938-0880
(602) 547-0528
Mailing address
5750 W THUNDERBIRD RD, H-850, GLENDALE, AZ 85306-4660
(602) 938-0880
(602) 547-0528
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2579
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
082115
CMDP
AZ
01
—
823999
UNITED CONCORDIA
AZ
01
—
AZ0116750
BCBS
AZ
Enumeration date
09/13/2006
Last updated
07/08/2007
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