Provider Demographics
NPI:1417149618
Name:JEFFERY E. HODGES DDS PC
Entity Type:Organization
Organization Name:JEFFERY E. HODGES DDS PC
Other - Org Name:ALBEMARLE DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-964-0088
Mailing Address - Street 1:2250 OLD IVY RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4820
Mailing Address - Country:US
Mailing Address - Phone:434-293-8944
Mailing Address - Fax:434-293-6572
Practice Address - Street 1:1769 WORTH PARK
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-7441
Practice Address - Country:US
Practice Address - Phone:434-964-0088
Practice Address - Fax:434-964-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006146122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1780875567OtherNPI TYPE 2