Provider Demographics
NPI:1194874156
Name:HODGES, KELLYN (DMD, MS)
Entity type:Individual
Prefix:
First Name:KELLYN
Middle Name:
Last Name:HODGES
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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:215-245-5100
Mailing Address - Fax:215-245-5220
Practice Address - Street 1:2212 STREET RD
Practice Address - Street 2:2ND FLOOR
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:215-245-5220
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0360451223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics