Provider Demographics
NPI:1518908649
Name:HODGES, GENOUS S (DDS)
Entity Type:Individual
Prefix:DR
First Name:GENOUS
Middle Name:S
Last Name:HODGES
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 1:1 VANDERBILT PARK DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1736
Mailing Address - Country:US
Mailing Address - Phone:828-274-8088
Mailing Address - Fax:
Practice Address - Street 1:1 VANDERBILT PARK DR
Practice Address - Street 2:SUITE 260
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1736
Practice Address - Country:US
Practice Address - Phone:828-274-8088
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC65701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC799005XMedicaid