Provider Demographics
NPI:1730345752
Name:HODGES, CLIFTON ARTHUR (DDS)
Entity type:Individual
Prefix:
First Name:CLIFTON
Middle Name:ARTHUR
Last Name:HODGES
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 1:23 LOUNDER DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEST BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530
Mailing Address - Country:US
Mailing Address - Phone:207-720-0997
Mailing Address - Fax:360-330-9580
Practice Address - Street 1:612 BRIGHTON AVENUE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-772-4359
Practice Address - Fax:207-772-4990
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE600225411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5057047Medicaid