Provider Demographics
NPI:1073724092
Name:HUDSON, CHARLES F (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:F
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 1:706 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4719
Mailing Address - Country:US
Mailing Address - Phone:337-238-2631
Mailing Address - Fax:337-238-0801
Practice Address - Street 1:706 S 6TH ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4719
Practice Address - Country:US
Practice Address - Phone:337-238-2631
Practice Address - Fax:337-238-0801
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA29871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice