Provider Demographics
NPI:1821105909
Name:E.W.HODGSON D.D.S. P.A. FAMILY DENTISTRY
Entity Type:Organization
Organization Name:E.W.HODGSON D.D.S. P.A. FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:WARD
Authorized Official - Last Name:HODGSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:321-254-4488
Mailing Address - Street 1:1250 W EAU GALLIE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-5383
Mailing Address - Country:US
Mailing Address - Phone:321-254-4488
Mailing Address - Fax:321-255-3335
Practice Address - Street 1:1250 W EAU GALLIE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-5383
Practice Address - Country:US
Practice Address - Phone:321-254-4488
Practice Address - Fax:321-255-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0009231261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental