Provider Demographics
NPI:1013028596
Name:HUDSON DENTAL ASSOC PA
Entity Type:Organization
Organization Name:HUDSON DENTAL ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:GAGNON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-889-8499
Mailing Address - Street 1:5 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051
Mailing Address - Country:US
Mailing Address - Phone:603-889-8499
Mailing Address - Fax:603-889-2199
Practice Address - Street 1:5 GEORGE ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NH
Practice Address - Zip Code:03051
Practice Address - Country:US
Practice Address - Phone:603-889-8499
Practice Address - Fax:603-889-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH2001122300000X
NHNH3314122300000X
NHNH3421122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty