Provider Demographics
NPI:1801807052
Name:HODGE, VERNETTA D (DDS)
Entity type:Individual
Prefix:MS
First Name:VERNETTA
Middle Name:D
Last Name:HODGE
Suffix:
Gender:F
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:BOX 400
Mailing Address - Street 2:SOLDIER CREEK ROAD
Mailing Address - City:ROSEBUD
Mailing Address - State:SD
Mailing Address - Zip Code:57570-0400
Mailing Address - Country:US
Mailing Address - Phone:605-747-2231
Mailing Address - Fax:604-747-3245
Practice Address - Street 1:SOLDIER CREEK ROAD
Practice Address - Street 2:
Practice Address - City:ROSEBUD
Practice Address - State:SD
Practice Address - Zip Code:57570-0400
Practice Address - Country:US
Practice Address - Phone:605-747-2231
Practice Address - Fax:604-747-3245
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADEN3312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist