1417149618 NPI number — JEFFERY E. HODGES DDS PC

Table of content: (NPI 1417149618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417149618 NPI number — JEFFERY E. HODGES DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFERY E. HODGES DDS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALBEMARLE DENTAL ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417149618
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2250 OLD IVY RD
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
CHARLOTTESVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22903-4820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-293-8944
Provider Business Mailing Address Fax Number:
434-293-6572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1769 WORTH PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22911-7441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-964-0088
Provider Business Practice Location Address Fax Number:
434-964-0088
Provider Enumeration Date:
08/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HODGES
Authorized Official First Name:
JEFFERY
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
434-964-0088

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  0401006146 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1780875567 . This is a "NPI TYPE 2" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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