Provider Demographics
NPI:1174688204
Name:HODOSH, STEVEN H (DMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:H
Last Name:HODOSH
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 1:243 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-1547
Mailing Address - Country:US
Mailing Address - Phone:401-467-4600
Mailing Address - Fax:401-781-9854
Practice Address - Street 1:243 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-1547
Practice Address - Country:US
Practice Address - Phone:401-467-4600
Practice Address - Fax:401-781-9854
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN 018541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI8982-7OtherBCBS
RIDEN999OtherMASHINTUCKET PEQUOT
MARG0053OtherBCBS OF MA