Provider Demographics
NPI:1700926631
Name:HODSON, MARK STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:HODSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:STEVEN
Other - Last Name:HODSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:330 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4465
Mailing Address - Country:US
Mailing Address - Phone:937-433-6903
Mailing Address - Fax:937-433-0641
Practice Address - Street 1:330 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4465
Practice Address - Country:US
Practice Address - Phone:937-433-6903
Practice Address - Fax:937-433-0641
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14095122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0269721Medicaid