Provider Demographics
NPI:1619320900
Name:PHILIP N. HODGE, DDS, PS
Entity Type:Organization
Organization Name:PHILIP N. HODGE, DDS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-852-4746
Mailing Address - Street 1:19221 108TH AVE SE STE 4
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-7369
Mailing Address - Country:US
Mailing Address - Phone:253-852-4746
Mailing Address - Fax:253-852-4754
Practice Address - Street 1:19221 108TH AVE SE STE 4
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-7369
Practice Address - Country:US
Practice Address - Phone:253-852-4746
Practice Address - Fax:253-852-4754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 00004936122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty