Provider Demographics
NPI:1235301995
Name:BENJAMIN J. HODGES, D.M.D., P.A.
Entity Type:Organization
Organization Name:BENJAMIN J. HODGES, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:JEMISON
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-583-2000
Mailing Address - Street 1:106 S 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-6001
Mailing Address - Country:US
Mailing Address - Phone:601-583-2000
Mailing Address - Fax:
Practice Address - Street 1:106 S 21ST AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-6001
Practice Address - Country:US
Practice Address - Phone:601-583-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3235-02261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental