Provider Demographics
NPI:1174511307
Name:HODSON, PRISCILLA LANE (DMD)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:LANE
Last Name:HODSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2100
Mailing Address - Country:US
Mailing Address - Phone:973-586-0530
Mailing Address - Fax:973-586-5272
Practice Address - Street 1:124 E MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2100
Practice Address - Country:US
Practice Address - Phone:973-586-0530
Practice Address - Fax:973-586-5272
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ139121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice