Provider Demographics
NPI:1710196860
Name:HODGES, STEVEN L (DDS)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:L
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 1:3420 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-8804
Mailing Address - Country:US
Mailing Address - Phone:574-256-1579
Mailing Address - Fax:574-256-5979
Practice Address - Street 1:3420 HICKORY RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-8804
Practice Address - Country:US
Practice Address - Phone:574-256-1579
Practice Address - Fax:574-256-5979
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009476122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist