Provider Demographics
NPI:1346500881
Name:HODGES, RYAN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:HODGES
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 LOMBARD ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5830
Mailing Address - Country:US
Mailing Address - Phone:805-495-5474
Mailing Address - Fax:
Practice Address - Street 1:250 LOMBARD ST
Practice Address - Street 2:SUITE 5
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5830
Practice Address - Country:US
Practice Address - Phone:805-495-5474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA603001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics