Provider Demographics
NPI:1780097238
Name:HODGES, AUSTIN SIDNEY (DDS)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:SIDNEY
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 1:3419 S COULTER ST STE 1
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-3998
Mailing Address - Country:US
Mailing Address - Phone:806-353-9862
Mailing Address - Fax:
Practice Address - Street 1:5212 S COULTER ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6404
Practice Address - Country:US
Practice Address - Phone:806-353-9862
Practice Address - Fax:806-359-7515
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29951122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No122300000XDental ProvidersDentist