Healthcare Provider Details

I. General information

NPI: 1154567055
Provider Name (Legal Business Name): JOHN A. HODGES DDS PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2008
Last Update Date: 12/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33301 9TH AVE S
FEDERAL WAY WA
98003-2602
US

IV. Provider business mailing address

33301 9TH AVE S
FEDERAL WAY WA
98003-2602
US

V. Phone/Fax

Practice location:
  • Phone: 253-946-6361
  • Fax:
Mailing address:
  • Phone: 253-946-6361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN ANDREW HODGES
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 253-946-6361