Provider Demographics
NPI:1144899782
Name:HODGE, THOMAS SOLOMON (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:SOLOMON
Last Name:HODGE
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 1:906 CYPRESS RD APT 215
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1425
Mailing Address - Country:US
Mailing Address - Phone:218-269-6374
Mailing Address - Fax:
Practice Address - Street 1:2860 W DIVISION ST STE 102
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-7330
Practice Address - Country:US
Practice Address - Phone:320-200-9011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14595122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist