Provider Demographics
NPI:1902214661
Name:HODGES, ERIC N (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:N
Last Name:HODGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 FENIMORE LANE
Mailing Address - Street 2:
Mailing Address - City:GLADWYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19035
Mailing Address - Country:US
Mailing Address - Phone:610-645-7640
Mailing Address - Fax:
Practice Address - Street 1:1 BELMONT AVE
Practice Address - Street 2:SUITE 316
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1617
Practice Address - Country:US
Practice Address - Phone:215-477-8941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028139L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics