Provider Demographics
NPI:1336705250
Name:HODGES, KAITLYN (DDS)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:HODGES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5418 VANDERBILT AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-6024
Mailing Address - Country:US
Mailing Address - Phone:901-573-3261
Mailing Address - Fax:
Practice Address - Street 1:2300 VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-3322
Practice Address - Country:US
Practice Address - Phone:972-845-8727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX372531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program