Provider Demographics
NPI:1730239195
Name:HODGES, NATHAN E (DDS, MS, PA)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:E
Last Name:HODGES
Suffix:
Gender:M
Credentials:DDS, MS, PA
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1010 W RALPH M HALL PKWY
Mailing Address - Street 2:STE. 101
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6655
Mailing Address - Country:US
Mailing Address - Phone:972-771-8640
Mailing Address - Fax:972-771-8638
Practice Address - Street 1:1010 W RALPH M HALL PKWY
Practice Address - Street 2:STE. 101
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6655
Practice Address - Country:US
Practice Address - Phone:972-771-8640
Practice Address - Fax:972-771-8638
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200611223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics