Provider Demographics
NPI:1528296423
Name:HODGES, MEGHAN CHRISTINE (DMD)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:CHRISTINE
Last Name:HODGES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10031 S YALE AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-6094
Mailing Address - Country:US
Mailing Address - Phone:918-528-3330
Mailing Address - Fax:918-528-3332
Practice Address - Street 1:10031 S YALE AVE STE 104
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-6094
Practice Address - Country:US
Practice Address - Phone:918-528-3330
Practice Address - Fax:918-528-3332
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK61321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200249770AMedicaid