Provider Demographics
NPI:1023481066
Name:ERIC D HODGES DDS PC
Entity type:Organization
Organization Name:ERIC D HODGES DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:D
Authorized Official - Last Name:HODGES DDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-397-3377
Mailing Address - Street 1:2410 SO. 73RD ST.
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2395
Mailing Address - Country:US
Mailing Address - Phone:402-397-3377
Mailing Address - Fax:402-343-1039
Practice Address - Street 1:2410 SO. 73RD ST.
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2395
Practice Address - Country:US
Practice Address - Phone:402-397-3377
Practice Address - Fax:402-343-1039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE55241223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty