Provider Demographics
NPI:1548303555
Name:JOHN B. CODJOE, D.D.S., P.C.
Entity type:Organization
Organization Name:JOHN B. CODJOE, D.D.S., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CODJOE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-771-7751
Mailing Address - Street 1:269 BARNSTABLE RD
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-2917
Mailing Address - Country:US
Mailing Address - Phone:508-771-7751
Mailing Address - Fax:508-827-4696
Practice Address - Street 1:269 BARNSTABLE ROAD
Practice Address - Street 2:
Practice Address - City:BARNSTABLE
Practice Address - State:MA
Practice Address - Zip Code:02601-3928
Practice Address - Country:US
Practice Address - Phone:508-771-7751
Practice Address - Fax:508-827-4696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855757302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9903933Medicaid