Provider Demographics
NPI:1174641104
Name:HUDSON, ROBERT JAMES
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAMES
Last Name:HUDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1609 PITT STREET RTE. 30 -EAST
Mailing Address - Street 2:JENNERSTOWN MEDICAL CENTER
Mailing Address - City:JENNERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15547-0210
Mailing Address - Country:US
Mailing Address - Phone:814-629-6621
Mailing Address - Fax:814-629-6622
Practice Address - Street 1:1609 PITT STREET RTE. 30 -EAST
Practice Address - Street 2:JENNERSTOWN MEDICAL CENTER
Practice Address - City:JENNERSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15547-0210
Practice Address - Country:US
Practice Address - Phone:814-629-6621
Practice Address - Fax:814-629-6622
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA020672-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice