Provider Demographics
NPI:1922849843
Name:KELLYN W. HODGES, DMD, MS, PC
Entity type:Organization
Organization Name:KELLYN W. HODGES, DMD, MS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-999-7008
Mailing Address - Street 1:1365 FENIMORE LN
Mailing Address - Street 2:
Mailing Address - City:GLADWYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19035-1333
Mailing Address - Country:US
Mailing Address - Phone:610-999-7008
Mailing Address - Fax:
Practice Address - Street 1:2212 STREET RD FL 2
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-3501
Practice Address - Country:US
Practice Address - Phone:215-245-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KELLYN W. HODGES, DMD, MS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty