Provider Demographics
NPI:1922287622
Name:HODGE, CYNTHIA ELOIS (DMD,MPH,MPA)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ELOIS
Last Name:HODGE
Suffix:
Gender:F
Credentials:DMD,MPH,MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 BRITTANY FARMS RD
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-1144
Mailing Address - Country:US
Mailing Address - Phone:860-679-3470
Mailing Address - Fax:860-670-1066
Practice Address - Street 1:12 WESTON ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-1504
Practice Address - Country:US
Practice Address - Phone:860-293-3101
Practice Address - Fax:860-293-3117
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009324122300000X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No122300000XDental ProvidersDentist