Provider Demographics
NPI:1396858643
Name:HUDSON, JAY C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:C
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 1:1270 STATE HIGHWAY 173 N
Mailing Address - Street 2:
Mailing Address - City:DEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:78016-4738
Mailing Address - Country:US
Mailing Address - Phone:830-663-4401
Mailing Address - Fax:830-663-5466
Practice Address - Street 1:1270 STATE HIGHWAY 173 N
Practice Address - Street 2:
Practice Address - City:DEVINE
Practice Address - State:TX
Practice Address - Zip Code:78016-4738
Practice Address - Country:US
Practice Address - Phone:830-663-4401
Practice Address - Fax:830-663-5466
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19037122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist