Provider Demographics
NPI:1043842917
Name:DR. PAGE HUDSON DENTAL CORPORATION
Entity Type:Organization
Organization Name:DR. PAGE HUDSON DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-877-7450
Mailing Address - Street 1:1164 NATIONAL DRIVE
Mailing Address - Street 2:SUITE 40
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834
Mailing Address - Country:US
Mailing Address - Phone:916-877-7450
Mailing Address - Fax:844-534-8464
Practice Address - Street 1:1671 EAST MONTE VISTA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688
Practice Address - Country:US
Practice Address - Phone:707-410-5437
Practice Address - Fax:844-534-8464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty