MEDICARE: GRANT HODGES D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	27909	FL

General Provider Information

NPI Number	:	1174217681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRANT HODGES D.D.S

Provider Business Mailing Address
First Line	:	8312 US HIGHWAY 301 N STE 101
Second Line	:
City	:	PARRISH
State	:	FL
Zip	:	34219-8725
Country	:	US
Telephone Number	:	941-776-0885
Fax Number	:

Provider Business Practice Location Address
First Line	:	8312 US HIGHWAY 301 N STE 101
Second Line	:
City	:	PARRISH
State	:	FL
Zip	:	34219-8725
Country	:	US
Telephone Number	:	941-776-0885
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2023
Last Update Date	:	06/07/2023

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