Basic Information
| Provider Information | |||||||||
| NPI: | 1184735839 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HODD | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 4323 HILL STREET | ||||||||
| Address2: | USA DENTAC | ||||||||
| City: | FT JACKSON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292076022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037516213 | ||||||||
| FaxNumber: | 8037516886 | ||||||||
| Practice Location | |||||||||
| Address1: | 4323 HILL STREET | ||||||||
| Address2: | USA DENTAC | ||||||||
| City: | FT JACKSON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292076022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037516213 | ||||||||
| FaxNumber: | 8037516886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 06/30/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 10754 | MN | N | Dental Providers | Dentist | 1223P0700X | 10754 | MN | Y | Dental Providers | Dentist | Prosthodontics |
No ID Information.