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General NPI Number Information
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NPI Number | 1033079645
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Entity Type | Organization
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Legal Business Name | HODGENVILLE FAMILY DENTISTRY
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Dates
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Enumeration Date | 11/15/2025
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Last Update Date | 11/15/2025
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Provider Practice Location Address
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Address Line | 104 N WALTERS AVE
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City | HODGENVILLE
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State | KY
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Zip | 42748-1532
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Country | US
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Telephone | 270-358-3189
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Fax | 270-358-3180
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Provider Business Mailing Address
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Address Line | 104 N WALTERS AVE
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City | HODGENVILLE
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State | KY
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Zip | 42748-1532
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Country | US
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Telephone | 270-358-3189
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Fax | 270-358-3180
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JOY GAMELIN
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Credential |
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Telephone | 270-312-4875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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