Provider Demographics
NPI:1073710141
Name:HODGES FAMILY DENTISTRY, P.A.
Entity Type:Organization
Organization Name:HODGES FAMILY DENTISTRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:TRACY
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:662-842-8514
Mailing Address - Street 1:634 SPICER DR STE B
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-1225
Mailing Address - Country:US
Mailing Address - Phone:662-842-8514
Mailing Address - Fax:662-842-8594
Practice Address - Street 1:634 SPICER DR STE B
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-1225
Practice Address - Country:US
Practice Address - Phone:662-842-8514
Practice Address - Fax:662-842-8594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3092-99122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty