Provider Demographics
NPI:1629125786
Name:HODNETT, SPENCER S (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:S
Last Name:HODNETT
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16143 LANCASTER HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277
Mailing Address - Country:US
Mailing Address - Phone:704-543-5000
Mailing Address - Fax:704-543-5006
Practice Address - Street 1:16143 LANCASTER HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277
Practice Address - Country:US
Practice Address - Phone:704-543-5000
Practice Address - Fax:704-543-5006
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC83581223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000634Medicaid