Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 10754 | MN |
Y | 1223P0700X | Prosthodontist | 10754 | MN |
NPI | 1184735839 |
---|---|
Provider Name | Dr. Jeffrey Alan Hodd |
First Address | Ft Jackson, SC 29207-6022 |
Second Address | Ft Jackson, SC 29207-6022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 30/06/2011 |