Provider Demographics
NPI:1831209931
Name:HODGE, DENNIS WILLIAM (DDS-ORTHODONTIST)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:WILLIAM
Last Name:HODGE
Suffix:
Gender:M
Credentials:DDS-ORTHODONTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6677 CROSSINGS DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-7889
Mailing Address - Country:US
Mailing Address - Phone:616-698-2323
Mailing Address - Fax:616-871-9253
Practice Address - Street 1:6677 CROSSINGS DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-7889
Practice Address - Country:US
Practice Address - Phone:616-698-2323
Practice Address - Fax:616-871-9253
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010106081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics