Healthcare Provider Details

I. General information

NPI: 1295862852
Provider Name (Legal Business Name): JAMES B HODGE III DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13129H N DALE MABRY HWY
TAMPA FL
33618-2405
US

IV. Provider business mailing address

13129-H NORTH DALE MABRY
TAMPA FL
33629
US

V. Phone/Fax

Practice location:
  • Phone: 813-960-8400
  • Fax: 813-963-3545
Mailing address:
  • Phone: 813-960-8400
  • Fax: 813-963-3545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN7270
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: