MEDICARE: MR. ELMER TERRELL 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	1223G0001X	General Practice Dentistry	9593	TX

General Provider Information

NPI Number	:	1225101439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ELMER TERRELL HODGES D.D.S.

Provider Business Mailing Address
First Line	:	4849 GREENVILLE AVE
Second Line	:	SUITE 173
City	:	DALLAS
State	:	TX
Zip	:	75206-4130
Country	:	US
Telephone Number	:	214-369-9966
Fax Number	:	214-368-0809

Provider Business Practice Location Address
First Line	:	4849 GREENVILLE AVE
Second Line	:	SUITE 173
City	:	DALLAS
State	:	TX
Zip	:	75206-4130
Country	:	US
Telephone Number	:	214-369-9966
Fax Number	:	214-368-0809

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/08/2007

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