Provider Demographics
NPI:1184614323
Name:HODGE, RICHARD MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MARK
Last Name:HODGE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 BURLINGTON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3409
Mailing Address - Country:US
Mailing Address - Phone:816-221-3255
Mailing Address - Fax:
Practice Address - Street 1:2029 BURLINGTON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3409
Practice Address - Country:US
Practice Address - Phone:816-221-3255
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO12477122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist