Healthcare Provider Details

I. General information

NPI: 1932525813
Provider Name (Legal Business Name): NATALIA HODGE DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 S UNIVERSITY AVE
LITTLE ROCK AR
72204-6018
US

IV. Provider business mailing address

312 N PINE ST
LITTLE ROCK AR
72205-4216
US

V. Phone/Fax

Practice location:
  • Phone: 501-712-5070
  • Fax:
Mailing address:
  • Phone: 870-450-4772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3980
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number019028810
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: