Provider Demographics
NPI:1972717858
Name:DR. BENJAMIN J. HODGES AND ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:DR. BENJAMIN J. HODGES AND ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTISTRY
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-764-2745
Mailing Address - Street 1:2683 HIGHWAY 15 SOUTH
Mailing Address - Street 2:P. O. BOX 1480
Mailing Address - City:BAY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39422
Mailing Address - Country:US
Mailing Address - Phone:601-764-2745
Mailing Address - Fax:601-764-3487
Practice Address - Street 1:2683 HWY. 15
Practice Address - Street 2:2683 HWY. 15
Practice Address - City:BAY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39422
Practice Address - Country:US
Practice Address - Phone:601-764-2745
Practice Address - Fax:601-764-3487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3235021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08878360Medicaid