Provider Demographics
NPI:1225101439
Name:HODGES, ELMER TERRELL (DDS)
Entity Type:Individual
Prefix:MR
First Name:ELMER
Middle Name:TERRELL
Last Name:HODGES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:TERRELL
Other - Middle Name:
Other - Last Name:HODGES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4849 GREENVILLE AVE
Mailing Address - Street 2:SUITE 173
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-4130
Mailing Address - Country:US
Mailing Address - Phone:214-369-9966
Mailing Address - Fax:214-368-0809
Practice Address - Street 1:4849 GREENVILLE AVE
Practice Address - Street 2:SUITE 173
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-4130
Practice Address - Country:US
Practice Address - Phone:214-369-9966
Practice Address - Fax:214-368-0809
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice