MEDICARE: DR. BRIAN DAVID HODGSON DDS

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	019-021052	IL
2	1223P0221X	Pediatric Dentistry	4214-015	WI

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	:	1982693099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN DAVID HODGSON DDS

Provider Business Mailing Address
First Line	:	1801 W WISCONSIN AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53233-2186
Country	:	US
Telephone Number	:	414-288-1566
Fax Number	:	414-288-0765

Provider Business Practice Location Address
First Line	:	1801 W WISCONSIN AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53233-2186
Country	:	US
Telephone Number	:	414-288-1566
Fax Number	:	414-288-0765

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	07/31/2008

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