Provider Demographics
NPI:1144580838
Name:HUDSON FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:HUDSON FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-448-7130
Mailing Address - Street 1:808 N MAPLE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MI
Mailing Address - Zip Code:49247-9767
Mailing Address - Country:US
Mailing Address - Phone:517-448-7130
Mailing Address - Fax:517-448-7198
Practice Address - Street 1:808 N MAPLE GROVE AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MI
Practice Address - Zip Code:49247-9767
Practice Address - Country:US
Practice Address - Phone:517-448-7130
Practice Address - Fax:517-448-7198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010178431223G0001X
MI29010179421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty