Healthcare Provider Details

I. General information

NPI: 1285149369
Provider Name (Legal Business Name): THOMAS E HODGE DOM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 CAMINO DE MONTE REY STE B3
SANTA FE NM
87505-3961
US

IV. Provider business mailing address

826 CAMINO DE MONTE REY STE B3
SANTA FE NM
87505-3961
US

V. Phone/Fax

Practice location:
  • Phone: 505-652-2053
  • Fax:
Mailing address:
  • Phone: 505-652-2053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1144
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: