Provider Demographics
NPI:1467546739
Name:HUDAK, KENNETH G (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:G
Last Name:HUDAK
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 1:748 ELMA ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-3063
Mailing Address - Country:US
Mailing Address - Phone:330-376-0097
Mailing Address - Fax:330-384-2147
Practice Address - Street 1:748 ELMA ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-3063
Practice Address - Country:US
Practice Address - Phone:330-376-0097
Practice Address - Fax:330-384-2147
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH189731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice