MEDICARE: DR. ROBERT HAROLD HODGERT DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4731	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4731	OTHER	OR	STATE LICENSE

General Provider Information

NPI Number	:	1023252384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT HAROLD HODGERT DMD

Provider Business Mailing Address
First Line	:	628 NW YORK DR STE 101
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-1572
Country	:	US
Telephone Number	:	541-389-2300
Fax Number	:	541-389-2301

Provider Business Practice Location Address
First Line	:	628 NW YORK DR STE 101
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-1572
Country	:	US
Telephone Number	:	541-389-2300
Fax Number	:	541-389-2301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2009
Last Update Date	:	06/10/2021

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