Provider Demographics
NPI:1104027143
Name:HODGES, JEFFERY EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:EUGENE
Last Name:HODGES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2250 OLD IVY RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4820
Mailing Address - Country:US
Mailing Address - Phone:434-293-8944
Mailing Address - Fax:434-293-6572
Practice Address - Street 1:2250 OLD IVY RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4820
Practice Address - Country:US
Practice Address - Phone:434-293-8944
Practice Address - Fax:434-293-6572
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA04010061461223G0001X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies