Healthcare Provider Details

I. General information

NPI: 1417149618
Provider Name (Legal Business Name): JEFFERY E. HODGES DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1769 WORTH PARK
CHARLOTTESVILLE VA
22911-7441
US

IV. Provider business mailing address

2250 OLD IVY RD SUITE 3
CHARLOTTESVILLE VA
22903-4820
US

V. Phone/Fax

Practice location:
  • Phone: 434-964-0088
  • Fax: 434-964-0088
Mailing address:
  • Phone: 434-293-8944
  • Fax: 434-293-6572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401006146
License Number StateVA

VIII. Authorized Official

Name: DR. JEFFERY EUGENE HODGES
Title or Position: PRESIDENT
Credential: DDS
Phone: 434-964-0088