Provider Demographics
NPI:1508441163
Name:HODNETT, KRYSTAL JUJUAN (RDH)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:JUJUAN
Last Name:HODNETT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:JUJUAN
Other - Last Name:HARDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:1035 NIDER BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23459-8701
Mailing Address - Country:US
Mailing Address - Phone:757-953-8334
Mailing Address - Fax:
Practice Address - Street 1:1035 NIDER BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23459-8701
Practice Address - Country:US
Practice Address - Phone:757-953-8334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH25462124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist