Provider Demographics
NPI:1003160706
Name:HODGE, KAREN A (RDH, MHSC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:HODGE
Suffix:
Gender:F
Credentials:RDH, MHSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-4214
Mailing Address - Country:US
Mailing Address - Phone:727-786-4938
Mailing Address - Fax:
Practice Address - Street 1:539 8TH ST
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-4214
Practice Address - Country:US
Practice Address - Phone:727-786-4938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH0008578124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist