Provider Demographics
NPI:1841314143
Name:HODGES, BRIAN CLARK (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CLARK
Last Name:HODGES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 WOODRUFF ROAD
Mailing Address - Street 2:SUITE G
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681
Mailing Address - Country:US
Mailing Address - Phone:864-297-1110
Mailing Address - Fax:864-297-1118
Practice Address - Street 1:2607 WOODRUFF ROAD
Practice Address - Street 2:SUITE G
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681
Practice Address - Country:US
Practice Address - Phone:864-297-1110
Practice Address - Fax:864-297-1118
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3677122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist