MEDICARE: JOHN HODGE, DMD, MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	273193	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578724506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN HODGE, DMD, MS

Provider Business Mailing Address
First Line	:	4227 POPLAR SPRINGS DR
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39305-3311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4227 POPLAR SPRINGS DR
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39305-3311
Country	:	US
Telephone Number	:	601-482-7700
Fax Number	:	601-482-0076

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN HODGE
Credential	:	DMD, MS
Telephone Number	:	601-482-7700

Provider Enumeration Date	:	06/23/2008
Last Update Date	:	06/23/2008

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