Provider Demographics
NPI:1033079645
Name:HODGENVILLE FAMILY DENTISTRY
Entity type:Organization
Organization Name:HODGENVILLE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMELIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-312-4875
Mailing Address - Street 1:104 N WALTERS AVE
Mailing Address - Street 2:
Mailing Address - City:HODGENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42748-1532
Mailing Address - Country:US
Mailing Address - Phone:270-358-3189
Mailing Address - Fax:270-358-3180
Practice Address - Street 1:104 N WALTERS AVE
Practice Address - Street 2:
Practice Address - City:HODGENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42748-1532
Practice Address - Country:US
Practice Address - Phone:270-358-3189
Practice Address - Fax:270-358-3180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-15
Last Update Date:2025-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty