Provider Demographics
NPI:1538234513
Name:HODGE, PHILIP NORMAN (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:NORMAN
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 1:19221 108TH AVE SE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-7369
Mailing Address - Country:US
Mailing Address - Phone:253-852-4746
Mailing Address - Fax:253-852-4754
Practice Address - Street 1:19221 108TH AVE SE
Practice Address - Street 2:SUITE 4
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-7369
Practice Address - Country:US
Practice Address - Phone:253-852-4746
Practice Address - Fax:253-852-4754
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4936122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist