Provider Demographics
NPI:1093879728
Name:HODGKINS, DUDLEY MCGRAW (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:DUDLEY
Middle Name:MCGRAW
Last Name:HODGKINS
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 S. LAKELINE BLVD.
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2963
Mailing Address - Country:US
Mailing Address - Phone:512-331-1419
Mailing Address - Fax:512-331-1648
Practice Address - Street 1:2515 S. LAKELINE BLVD.
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2963
Practice Address - Country:US
Practice Address - Phone:512-331-1419
Practice Address - Fax:512-331-1648
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111861223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics