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General NPI Number Information
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NPI Number | 1841738200
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Entity Type | Individual
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Provider Name | SHANE PHILIP HODSON D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 02/06/2017
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Provider Practice Location Address
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Address Line | 18333 NE 19TH AVE
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33179-5031
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Country | US
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Telephone | 305-725-8907
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 ISLAND BLVD APT 1402
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City | AVENTURA
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State | FL
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Zip | 33160-4923
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Country | US
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Telephone | 305-725-8907
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 21710
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License Number State | FL
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