Wallace C Hodge, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D3240 Issued in OR

Practice address

14425 SW Allen Blvd
Beaverton, OR 97005-4402

Phone

(503) 520-0707

Fax

(503) 643-0677

NPI assigned

Dec 1, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1982772679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6950 NE CAMPUS WAY",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971245611",
            "telephone_number": "503-952-2164",
            "fax_number": "503-526-4418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14425 SW ALLEN BLVD",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970054402",
            "telephone_number": "503-520-0707",
            "fax_number": "503-643-0677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HODGE",
        "first_name": "WALLACE",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D3240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nhu Hoang
• Susan Laurie Hobbel, PT
• Donna M Hobson
• Jennifer E Hockema, RDH
• Denise Julie Hockley, LMFT
• Amalie K Hodges
• Brent Hodgson, LMT
• Seneca J Hofbauer, BCBA
• Dixie Hofer
• Chantell Marie Hoffman, PA -C

• General Practice Dentistry in Beaverton, OR
• Providers in Beaverton, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.