Provider Demographics
NPI:1821629049
Name:DANIEL A HODGES
Entity Type:Organization
Organization Name:DANIEL A HODGES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-267-6318
Mailing Address - Street 1:1190 WEST SPRING ST, SUITE A
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655
Mailing Address - Country:US
Mailing Address - Phone:770-267-6318
Mailing Address - Fax:678-635-6159
Practice Address - Street 1:1190 WEST SPRING ST, SUITE A
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655
Practice Address - Country:US
Practice Address - Phone:770-267-6318
Practice Address - Fax:678-635-6159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty