Provider Demographics
NPI:1427186840
Name:HUDAK, SUSAN ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:HUDAK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9160 OAKHURST RD
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-2157
Mailing Address - Country:US
Mailing Address - Phone:727-595-4525
Mailing Address - Fax:727-596-4161
Practice Address - Street 1:9160 OAKHURST RD
Practice Address - Street 2:SUITE # 2
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776-2157
Practice Address - Country:US
Practice Address - Phone:727-595-4525
Practice Address - Fax:727-596-4161
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00141041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice