Provider Demographics
NPI:1033207022
Name:HUDSON, MICHAEL WADE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WADE
Last Name:HUDSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 S LINDSAY RD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-0701
Mailing Address - Country:US
Mailing Address - Phone:480-855-5582
Mailing Address - Fax:480-855-5780
Practice Address - Street 1:3011 S LINDSAY RD
Practice Address - Street 2:SUITE 119
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-0701
Practice Address - Country:US
Practice Address - Phone:480-855-5582
Practice Address - Fax:480-855-5780
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5459122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist