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General NPI Number Information
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NPI Number | 1679634109
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Entity Type | Organization
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Legal Business Name | HODOSH DENTAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 05/26/2009
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Provider Practice Location Address
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Address Line | 243 ELMWOOD AVE
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City | PROVIDENCE
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State | RI
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Zip | 02907-1547
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Country | US
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Telephone | 401-467-4600
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Fax | 401-781-9854
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Provider Business Mailing Address
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Address Line | 243 ELMWOOD AVE
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City | PROVIDENCE
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State | RI
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Zip | 02907-1547
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Country | US
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Telephone | 401-467-4600
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Fax | 401-781-9854
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Authorized Official
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Title or Position | DR. -MANAGER
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Name | DR. ALEX HODOSH
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Credential | DMD
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Telephone | 401-467-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 1854
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2280
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1854
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License Number State | RI
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Taxonomy #4
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | 2280
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License Number State | RI
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Taxonomy #5
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 2280
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License Number State | RI
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Taxonomy #6
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 2280
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License Number State | RI
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Taxonomy #7
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Taxonomy Code | 122400000X
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Taxonomy Name | Denturist
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License Number | 2280
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License Number State | RI
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Taxonomy #8
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 2280
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License Number State | RI
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