Provider Demographics
NPI:1053643973
Name:DODSON, MATTHEW C (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:C
Last Name:DODSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1671
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96767-1671
Mailing Address - Country:US
Mailing Address - Phone:808-667-7033
Mailing Address - Fax:
Practice Address - Street 1:845 WAINEE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-2321
Practice Address - Country:US
Practice Address - Phone:808-667-7033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI24001223G0001X
CA587381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice