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General NPI Number Information
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NPI Number | 1578724506
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Entity Type | Organization
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Legal Business Name | JOHN HODGE, DMD, MS
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 4227 POPLAR SPRINGS DR
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City | MERIDIAN
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State | MS
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Zip | 39305-3311
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Country | US
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Telephone | 601-482-7700
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Fax | 601-482-0076
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Provider Business Mailing Address
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Address Line | 4227 POPLAR SPRINGS DR
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City | MERIDIAN
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State | MS
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Zip | 39305-3311
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN HODGE
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Credential | DMD, MS
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Telephone | 601-482-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 273193
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License Number State | MS
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