Provider Demographics
NPI:1427277359
Name:HODNIK, VICKEY J (DDS)
Entity type:Individual
Prefix:DR
First Name:VICKEY
Middle Name:J
Last Name:HODNIK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 LAKE ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7651
Mailing Address - Country:US
Mailing Address - Phone:907-235-7585
Mailing Address - Fax:907-235-7311
Practice Address - Street 1:4014 LAKE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7651
Practice Address - Country:US
Practice Address - Phone:907-235-7585
Practice Address - Fax:907-235-7311
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK692122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist