Healthcare Provider Details

I. General information

NPI: 1427216829
Provider Name (Legal Business Name): ASHLEY BROOKE HODERS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 OLIVE WAY STE 810
SEATTLE WA
98101-1836
US

IV. Provider business mailing address

8226 S 15TH ST
TACOMA WA
98465-2243
US

V. Phone/Fax

Practice location:
  • Phone: 206-628-0404
  • Fax:
Mailing address:
  • Phone: 954-254-8307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN17949
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDE60545349
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: