Provider Demographics
NPI:1497889976
Name:KING, DANA HODGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:HODGE
Last Name:KING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7870 BROADWAY ST
Mailing Address - Street 2:B-102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2561
Mailing Address - Country:US
Mailing Address - Phone:210-829-7826
Mailing Address - Fax:210-829-8124
Practice Address - Street 1:7870 BROADWAY ST
Practice Address - Street 2:B-102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2561
Practice Address - Country:US
Practice Address - Phone:210-829-7826
Practice Address - Fax:210-829-8124
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX136401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice