Individual
MR. JAMES WALTER HODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
620 1ST AVENUE NORTH, KETCHUM, ID 83340-2273
(208) 726-2233
Mailing address
PO BOX 2273, KETCHUM, ID 83340-2273
(208) 726-2233
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-2023
ID
Other
Enumeration date
11/14/2011
Last updated
11/14/2011
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