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NPI Code Detail

MEDICARE: DR. BRIAN DAVID HODGSON DDS

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
11223G0001XGeneral Practice Dentistry019-021052IL
21223P0221XPediatric Dentistry4214-015WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID 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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