Provider Demographics
NPI:1306844527
Name:HUDETZ, PATRICIA K (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:K
Last Name:HUDETZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10334 STATE ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8153
Mailing Address - Country:US
Mailing Address - Phone:630-904-1106
Mailing Address - Fax:630-904-5404
Practice Address - Street 1:10334 STATE ROUTE 59
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8153
Practice Address - Country:US
Practice Address - Phone:630-904-1106
Practice Address - Fax:630-904-5404
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist