Healthcare Provider Details

I. General information

NPI: 1689597197
Provider Name (Legal Business Name): STEPHANIE HODGE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 WILCOX ST STE 200
CASTLE ROCK CO
80104-2049
US

IV. Provider business mailing address

PO BOX 222
ELIZABETH CO
80107-0222
US

V. Phone/Fax

Practice location:
  • Phone: 785-760-0105
  • Fax:
Mailing address:
  • Phone: 785-760-0105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH.002027277
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: