Provider Demographics
NPI:1164448320
Name:S. CLINT HUDSON, D.M.D., M.D., L.L.C.
Entity Type:Organization
Organization Name:S. CLINT HUDSON, D.M.D., M.D., L.L.C.
Other - Org Name:S. CLINT HUDSON, D.M.D., M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:S
Authorized Official - Middle Name:CLINT
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:256-533-1282
Mailing Address - Street 1:2317 WHITESBURG DR S
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3819
Mailing Address - Country:US
Mailing Address - Phone:256-533-1282
Mailing Address - Fax:256-533-1288
Practice Address - Street 1:2317 WHITESBURG DR S
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3819
Practice Address - Country:US
Practice Address - Phone:256-533-1282
Practice Address - Fax:256-533-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL50511223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001858654OtherUNITED CONCORDIA
AL529928780Medicaid
ALK919OtherMEDICARE
AL51003400OtherBLUECROSS BLUESHIELD AL
TN4129232OtherBLUECROSS BLUESHIELD TN
AL51136356OtherBLUECROSS BLUESHIELD AL