Provider Demographics
NPI:1275277014
Name:THOMAS W HODGE DMD PA
Entity Type:Organization
Organization Name:THOMAS W HODGE DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:662-563-9550
Mailing Address - Street 1:PO BOX 473
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-0473
Mailing Address - Country:US
Mailing Address - Phone:662-563-9550
Mailing Address - Fax:662-563-9530
Practice Address - Street 1:310 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-2635
Practice Address - Country:US
Practice Address - Phone:662-563-9550
Practice Address - Fax:662-563-9530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty