Provider Demographics
NPI:1790860401
Name:HODGE, DENNIS L (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:L
Last Name:HODGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9110 ANDERMATT DR STE 2
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-6701
Mailing Address - Country:US
Mailing Address - Phone:402-483-7641
Mailing Address - Fax:402-483-0527
Practice Address - Street 1:9110 ANDERMATT DR STE 2
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-6701
Practice Address - Country:US
Practice Address - Phone:402-483-7641
Practice Address - Fax:402-483-0527
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-05-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE13085207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-0546525-12Medicaid
NE47-0546525-12Medicaid
279624Medicare ID - Type Unspecified