Provider Demographics
NPI:1467541565
Name:HODGE, BRANDON GALEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:GALEN
Last Name:HODGE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 ANTEBELLUM CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-7096
Mailing Address - Country:US
Mailing Address - Phone:615-822-5678
Mailing Address - Fax:
Practice Address - Street 1:1020 ANTEBELLUM CIR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-7096
Practice Address - Country:US
Practice Address - Phone:615-822-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS7249122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist