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General NPI Number Information
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NPI Number | 1417149618
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Entity Type | Organization
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Legal Business Name | JEFFERY E. HODGES DDS PC
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 1769 WORTH PARK
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-7441
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Country | US
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Telephone | 434-964-0088
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Fax | 434-964-0088
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Provider Business Mailing Address
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Address Line | 2250 OLD IVY RD SUITE 3
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-4820
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Country | US
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Telephone | 434-293-8944
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Fax | 434-293-6572
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFERY EUGENE HODGES
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Credential | DDS
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Telephone | 434-964-0088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401006146
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License Number State | VA
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