Active NPI
Kristin S Hodgson, DMD
- Dentist
- Middleburg, FL
National Provider Identifier
1669786984
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN19166
- Practice address
- 3200 Old Jennings Rd
Middleburg, FL 32068-3414 - Phone
- (904) 505-2010
- Fax
- (904) 505-2011
- NPI assigned
- Jul 28, 2010
- Last updated
- Jul 15, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN19166 | FL | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X | 0442000150 | VA |
Addresses
Primary practice location
3200 Old Jennings Rd
Middleburg, FL 32068-3414
Mailing address
3200 Old Jennings Rd
Middleburg, FL 32068-3414
Phone (904) 505-2010
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 11, 2017 through Jan 11, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN19166 | FL | MD | Dentist |
| 0442000150 | VA | MD | Student in an Organized Health Care Education/Training Program |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Myers Pediatric Dentistry PA | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Pediatric Dentistry
- Middleburg, FL
- NPI 1982619425
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373846400000",
"number": "1669786984",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3200 OLD JENNINGS RD",
"city": "MIDDLEBURG",
"state": "FL",
"postal_code": "320683414",
"telephone_number": "904-505-2010",
"fax_number": "904-505-2011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 OLD JENNINGS RD",
"city": "MIDDLEBURG",
"state": "FL",
"postal_code": "320683414",
"telephone_number": "904-505-2010",
"fax_number": "904-505-2011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HODGSON",
"first_name": "KRISTIN",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-07-28",
"last_updated": "2013-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN19166",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "VA",
"license": "0442000150",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middleburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.