Provider Demographics
NPI:1164430120
Name:HODGE, JAY TALBOT (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:TALBOT
Last Name:HODGE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 SPRING STREET
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-2001
Mailing Address - Country:US
Mailing Address - Phone:781-826-5490
Mailing Address - Fax:
Practice Address - Street 1:255 CHIEF JUSTICE CUSHING HWY
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-4442
Practice Address - Country:US
Practice Address - Phone:781-545-3466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA180701223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics