Provider Demographics
NPI:1457422305
Name:HODOVAL, RANDALL JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:JAMES
Last Name:HODOVAL
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 1:14955 S VAN DYKE RD
Mailing Address - Street 2:UNIT100
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-5804
Mailing Address - Country:US
Mailing Address - Phone:815-436-4900
Mailing Address - Fax:815-436-6139
Practice Address - Street 1:14955 S VAN DYKE RD
Practice Address - Street 2:UNIT100
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-5804
Practice Address - Country:US
Practice Address - Phone:815-436-4900
Practice Address - Fax:815-436-6139
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190176211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice