MEDICARE: MRS. CRISELDA T HODGENS 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	43169	CA

General Provider Information

NPI Number	:	1356409668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CRISELDA T HODGENS DMD

Provider Business Mailing Address
First Line	:	2020 COFFEE RD
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95355-2427
Country	:	US
Telephone Number	:	209-571-9855
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 COFFEE RD
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95355-2427
Country	:	US
Telephone Number	:	209-571-9855
Fax Number	:

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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