Healthcare Provider Details

I. General information

NPI: 1184735839
Provider Name (Legal Business Name): JEFFREY ALAN HODD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4323 HILL STREET USA DENTAC
FT JACKSON SC
29207-6022
US

IV. Provider business mailing address

4323 HILL STREET USA DENTAC
FT JACKSON SC
29207-6022
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-6213
  • Fax: 803-751-6886
Mailing address:
  • Phone: 803-751-6213
  • Fax: 803-751-6886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10754
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number10754
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: