Healthcare Provider Details

I. General information

NPI: 1780875567
Provider Name (Legal Business Name): JEFFERY E. HODGES DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401006146
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFERY EUGENE HODGES
Title or Position: PRESIDENT
Credential: DDS
Phone: 434-293-8944