Provider Demographics
NPI:1750412037
Name:HODGES, RUSSELL ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:ROBERT
Last Name:HODGES
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 1:32905 12 MILE RD
Mailing Address - Street 2:STE 120
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334
Mailing Address - Country:US
Mailing Address - Phone:248-553-3553
Mailing Address - Fax:248-553-3565
Practice Address - Street 1:32905 12 MILE RD
Practice Address - Street 2:STE 120
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:248-553-3553
Practice Address - Fax:248-553-3565
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013759122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist