=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770214207
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HODGES FAMILY DENTISTRY OF BRAINTREE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2022
-----------------------------------------------------
Last Update Date | 06/24/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 575 WASHINGTON ST
-----------------------------------------------------
City | BRAINTREE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02184-5614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-848-2444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 575 WASHINGTON ST
-----------------------------------------------------
City | BRAINTREE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02184-5614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-848-2444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. PARKER HODGES
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 434-203-7645
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------