Provider Demographics
NPI:1922983964
Name:1041 DODDS MT. PLEASANT PROFESSIONAL, PLLC
Entity type:Organization
Organization Name:1041 DODDS MT. PLEASANT PROFESSIONAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPS
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-391-4086
Mailing Address - Street 1:1041 JOHNNIE DODDS BLVD STE 1A
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-6156
Mailing Address - Country:US
Mailing Address - Phone:843-884-6004
Mailing Address - Fax:
Practice Address - Street 1:1041 JOHNNIE DODDS BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-6156
Practice Address - Country:US
Practice Address - Phone:843-884-6004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental