Provider Demographics
NPI:1063657211
Name:HUDSON, PATRICK M (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:M
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 1:123 W CASCADE WAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6017
Mailing Address - Country:US
Mailing Address - Phone:509-467-1234
Mailing Address - Fax:509-467-1235
Practice Address - Street 1:123 W CASCADE WAY
Practice Address - Street 2:SUITE D
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6017
Practice Address - Country:US
Practice Address - Phone:509-467-1234
Practice Address - Fax:509-467-1235
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 600288111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice