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  5. HODOSH DENTAL ASSOCIATES, INC.

HODOSH DENTAL ASSOCIATES, INC.

Company Details

Name: HODOSH DENTAL ASSOCIATES, INC.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Activ
Date of Organization in Rhode Island: 31 Dec 1971 (53 years ago)
Identification Number: 000017190
ZIP code: 02907
County: Providence County
Principal Address: 243 ELMWOOD AVENUE, PROVIDENCE, RI, 02907, USA
Purpose: PROVIDING DENTAL SERVICES AS DEFINED IN SECTION 7-5.1 OF THE RHODE ISLAND GENERAL LAWS AS AMENDED
NAICS: 621210 - Offices of Dentists
Historical names: MILTON HODOSH, D.M.D., INC.

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1679634109 2006-12-12 2009-05-26 243 ELMWOOD AVE, PROVIDENCE, RI, 029071547, US 243 ELMWOOD AVE, PROVIDENCE, RI, 029071547, US

Contacts
Phone +1 401-467-4600
Fax 4017819854

Authorized person
Name DR. ALEX HODOSH
Role DR. -MANAGER
Phone 4014674600

Taxonomy
Taxonomy Code 1223E0200X - Endodontist
License Number 2280
State RI
Is Primary Yes
Taxonomy Code 1223E0200X - Endodontist
License Number 1854
State RI
Is Primary No
Taxonomy Code 1223G0001X - General Practice Dentistry
License Number 2280
State RI
Is Primary No
Taxonomy Code 1223G0001X - General Practice Dentistry
License Number 1854
State RI
Is Primary No
Taxonomy Code 1223P0106X - Oral and Maxillofacial Pathology Dentist
License Number 2280
State RI
Is Primary No
Taxonomy Code 1223P0300X - Periodontist
License Number 2280
State RI
Is Primary No
Taxonomy Code 1223S0112X - Oral and Maxillofacial Surgery (Dentist)
License Number 2280
State RI
Is Primary No
Taxonomy Code 122400000X - Denturist
License Number 2280
State RI
Is Primary No

Other Provider Identifiers
Issuer BLUE CROSS BLUE SHIELD RI
Number 8982-7
State RI
Issuer MASHENTUCKET-PEQUOT
Number DEN999
State RI
Issuer BLUE CROSS BLUE SHEILD MA
Number RG0053
State MA
Issuer UNITED CONCORDIA
Number 780979
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
HODOSH DENTAL ASSOCIATES, INC. 401(K) PLAN 2023 050346651 2024-07-24 HODOSH DENTAL ASSOCIATES, INC. 14
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4014674600
Plan sponsor’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 02907

Signature of
Role Plan administrator
Date 2024-07-24
Name of individual signing ALEX J. HODOSH
Valid signature Filed with authorized/valid electronic signature
HODOSH DENTAL ASSOCIATES, INC. CASH BALANCE PLAN 2023 050346651 2024-10-02 HODOSH DENTAL ASSOCIATES, INC. 9
File View Page
Three-digit plan number (PN) 005
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 4014674600
Plan sponsor’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 02904

Signature of
Role Plan administrator
Date 2024-10-02
Name of individual signing ALEX J. HODOSH D.M.D.
Valid signature Filed with authorized/valid electronic signature
HODOSH DENTAL ASSOCIATES, INC. CASH BALANCE PLAN 2022 050346651 2023-07-13 HODOSH DENTAL ASSOCIATES, INC. 9
File View Page
Three-digit plan number (PN) 005
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 4014674600
Plan sponsor’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 02904

Signature of
Role Plan administrator
Date 2023-07-13
Name of individual signing ALEX J. HODOSH D.M.D.
Valid signature Filed with authorized/valid electronic signature
HODOSH DENTAL ASSOCIATES, INC. 401(K) PLAN 2022 050346651 2023-10-02 HODOSH DENTAL ASSOCIATES, INC. 15
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4014674600
Plan sponsor’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 02907

Signature of
Role Plan administrator
Date 2023-10-02
Name of individual signing ALEX J. HODOSH
Valid signature Filed with authorized/valid electronic signature
HODOSH DENTAL ASSOCIATES, INC. 401(K) PLAN 2021 050346651 2022-10-10 HODOSH DENTAL ASSOCIATES, INC. 12
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4014674600
Plan sponsor’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 02907

Signature of
Role Plan administrator
Date 2022-10-10
Name of individual signing ALEX J. HODOSH
Valid signature Filed with authorized/valid electronic signature
HODOSH DENTAL ASSOCIATES, INC. CASH BALANCE PLAN 2021 050346651 2022-09-22 HODOSH DENTAL ASSOCIATES, INC. 7
File View Page
Three-digit plan number (PN) 005
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 4014674600
Plan sponsor’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 02904

Signature of
Role Plan administrator
Date 2022-09-22
Name of individual signing ALEX J. HODOSH D.M.D.
Valid signature Filed with authorized/valid electronic signature
HODOSH DENTAL ASSOCIATES, INC. 401(K) PLAN 2020 050346651 2021-09-30 HODOSH DENTAL ASSOCIATES, INC. 12
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4014674600
Plan sponsor’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 02907

Signature of
Role Plan administrator
Date 2021-09-30
Name of individual signing ALEX J. HODOSH
Valid signature Filed with authorized/valid electronic signature
HODOSH DENTAL ASSOCIATES, INC. CASH BALANCE PLAN 2020 050346651 2021-09-27 HODOSH DENTAL ASSOCIATES, INC. 8
File View Page
Three-digit plan number (PN) 005
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 4014674600
Plan sponsor’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 02907

Signature of
Role Plan administrator
Date 2021-09-27
Name of individual signing ALEX J. HODOSH D.M.D.
Valid signature Filed with authorized/valid electronic signature
HODOSH DENTAL ASSOCIATES, INC. CASH BALANCE PLAN 2019 050346651 2020-10-02 HODOSH DENTAL ASSOCIATES, INC. 7
File View Page
Three-digit plan number (PN) 005
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 4014674600
Plan sponsor’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 02907
HODOSH DENTAL ASSOCIATES, INC. 401(K) PLAN 2019 050346651 2020-10-05 HODOSH DENTAL ASSOCIATES, INC. 10
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4014674600
Plan sponsor’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 02907
File https://efast2-filings-public.s3.amazonaws.com/prd/2019/04/03/20190403072049P040000193328001.pdf
Three-digit plan number (PN) 004
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4017813591
Plan sponsor’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 02907
File https://efast2-filings-public.s3.amazonaws.com/prd/2018/08/13/20180813093542P040056910191001.pdf
Three-digit plan number (PN) 004
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4017813591
Plan sponsor’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 02907
File https://efast2-filings-public.s3.amazonaws.com/prd/2017/08/08/20170808083218P040068777533001.pdf
Three-digit plan number (PN) 004
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4017813591
Plan sponsor’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 02907
File https://efast2-filings-public.s3.amazonaws.com/prd/2016/05/19/20160519132752P040075824263001.pdf
Three-digit plan number (PN) 004
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4017813591
Plan sponsor’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 02907
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/10/13/20151013075645P040040624727001.pdf
Three-digit plan number (PN) 004
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4017813591
Plan sponsor’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 02907

Signature of
Role Plan administrator
Date 2015-10-13
Name of individual signing ALEX J. HODOSH
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/07/11/20140711124222P040011440799001.pdf
Three-digit plan number (PN) 004
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4017813591
Plan sponsor’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 029071547

Signature of
Role Plan administrator
Date 2014-07-11
Name of individual signing ALEX J. HODOSH DMD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/10/08/20131008124601P030025167923001.pdf
Three-digit plan number (PN) 004
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4017813591
Plan sponsor’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 029071547

Plan administrator’s name and address
Administrator’s EIN 050346651
Plan administrator’s name HODOSH DENTAL ASSOCIATES, INC.
Plan administrator’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 029071547
Administrator’s telephone number 4017813591

Signature of
Role Plan administrator
Date 2013-10-08
Name of individual signing ALEX J. HODOSH DMD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/06/28/20120628133845P030004451414001.pdf
Three-digit plan number (PN) 004
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4017813591
Plan sponsor’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 029071547

Plan administrator’s name and address
Administrator’s EIN 050346651
Plan administrator’s name HODOSH DENTAL ASSOCIATES, INC.
Plan administrator’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 029071547
Administrator’s telephone number 4017813591

Signature of
Role Plan administrator
Date 2012-06-28
Name of individual signing ALEX J. HODOSH DMD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/05/25/20110525201025P040303196544001.pdf
Three-digit plan number (PN) 004
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4017813591
Plan sponsor’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 029071547

Plan administrator’s name and address
Administrator’s EIN 050346651
Plan administrator’s name HODOSH DENTAL ASSOCIATES, INC.
Plan administrator’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 029071547
Administrator’s telephone number 4017813591

Signature of
Role Plan administrator
Date 2011-05-25
Name of individual signing ALEX J. HODOSH, DMD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/07/27/20100727081041P040015097541001.pdf
Three-digit plan number (PN) 004
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4017813591
Plan sponsor’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 029071547

Plan administrator’s name and address
Administrator’s EIN 050346651
Plan administrator’s name HODOSH DENTAL ASSOCIATES, INC.
Plan administrator’s address 243 ELMWOOD AVENUE, PROVIDENCE, RI, 029071547
Administrator’s telephone number 4017813591

Signature of
Role Plan administrator
Date 2010-07-27
Name of individual signing ALEX J. HODOSH, DMD
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
ALEX J. HODOSH Agent 243 ELMWOOD AVENUE, PROVIDENCE, RI, 02907, USA

PRESIDENT

Name Role Address
ALEX J. HODOSH PRESIDENT 243 ELMWOOD AVENUE PROVIDENCE, RI 02907 USA

Events

Type Date Old Value New Value
Name Change 1996-11-07 MILTON HODOSH, D.M.D., INC. HODOSH DENTAL ASSOCIATES, INC.

Filings

Number Name File Date
202445725810 Annual Report 2024-02-06
202327245520 Annual Report 2023-02-02
202209288720 Annual Report 2022-02-03
202185973050 Annual Report 2021-01-13
202031205430 Annual Report 2020-01-07
201988632030 Annual Report 2019-03-14
201988631330 Statement of Change of Registered/Resident Agent 2019-03-14
201859583700 Annual Report 2018-03-01
201734511020 Annual Report 2017-02-21
201691227350 Annual Report 2016-01-25

Related by officers

No related officers

Related by address

243 ELMWOOD AVENUE, PROVIDENCE, RI, 02907, USA

WHITMARSH REALTY CORP.

Date of last update: 06 Oct 2024

Sources: Rhode Island Department of State

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