Provider Demographics
NPI:1417351388
Name:HODGDON, DANA FAULKNER (MA)
Entity Type:Individual
Prefix:MR
First Name:DANA
Middle Name:FAULKNER
Last Name:HODGDON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23461 SOUTH POINTE DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-452-0888
Mailing Address - Fax:
Practice Address - Street 1:23461 SOUTH POINTE DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-452-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program