John R Dodge, DMD,MS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

CO7489 Issued in CO

Practice address

1440 28TH St
Suite 1
Boulder, CO 80303-1030

Phone

(303) 447-0460

Fax

(303) 447-9578

NPI assigned

Apr 4, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629190194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1440 28TH ST",
            "address_2": "SUITE 1",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803031030",
            "telephone_number": "303-447-0460",
            "fax_number": "303-447-9578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 28TH ST",
            "address_2": "SUITE 1",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803031030",
            "telephone_number": "303-447-0460",
            "fax_number": "303-447-9578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DODGE",
        "first_name": "JOHN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DMD,MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CO",
            "license": "CO7489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Dixon, LPCC
• Daniel Dlugose
• Ana M DO Valle, OTR
• Sarah Dobson
• Janis Dochterman, MA, LPCC, RYT
• William Harold Dodson III, MD
• Ethan Doe
• Hannah Doenlen
• Tracy Doering
• Amanda Masek Doetsch, PA-C

• Periodontics in Boulder, CO
• Providers in Boulder, CO by specialty
• Periodontics in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.