Individual
DR. GRAY HODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
501 N 6TH ST, BLYTHEVILLE, AR 72315-2407
(870) 763-2100
(870) 762-5383
Mailing address
1805 MARILYN DR, CARUTHERSVLLE, MO 63830-2349
(870) 623-0040
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4184
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2017013084
MISSOURI DENTAL LICENSE
MO
01
—
4184
ARKANSAS DENTAL LICENSE
AR
Enumeration date
06/23/2017
Last updated
06/23/2017
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