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General NPI Number Information
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NPI Number | 1881114478
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Entity Type | Organization
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Legal Business Name | HODGE DENTAL, PLLC
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Dates
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Enumeration Date | 06/23/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 501 N 6TH ST
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City | BLYTHEVILLE
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State | AR
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Zip | 72315-2407
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Country | US
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Telephone | 780-763-2100
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Fax | 870-762-5383
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Provider Business Mailing Address
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Address Line | 501 N 6TH ST
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City | BLYTHEVILLE
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State | AR
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Zip | 72315-2407
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Country | US
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Telephone | 780-763-2100
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Fax | 870-762-5383
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Authorized Official
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Title or Position | DENTIST
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Name | DR. GRAY HODGE
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Credential | DMD
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Telephone | 870-763-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 1226
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License Number State | AR
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