Provider Demographics
NPI:1780875567
Name:JEFFERY E. HODGES DDS PC
Entity type:Organization
Organization Name:JEFFERY E. HODGES DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-293-8944
Mailing Address - Street 1:2250 OLD IVY RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4820
Mailing Address - Country:US
Mailing Address - Phone:434-293-8944
Mailing Address - Fax:434-293-6572
Practice Address - Street 1:2250 OLD IVY RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4820
Practice Address - Country:US
Practice Address - Phone:434-293-8944
Practice Address - Fax:434-293-6572
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFERY E. HODGES DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-06
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010061461223G0001X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA110427143OtherTYPE 1 NPI