Provider Demographics
NPI:1467660928
Name:HUDSON, JOSEPH T (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:T
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 1:2840 N HIGH SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SPEEDWAY
Mailing Address - State:IN
Mailing Address - Zip Code:46224-4724
Mailing Address - Country:US
Mailing Address - Phone:317-293-4123
Mailing Address - Fax:317-293-1099
Practice Address - Street 1:2840 N. HIGH SCHOOL RD.
Practice Address - Street 2:
Practice Address - City:SPEEDWAY
Practice Address - State:IN
Practice Address - Zip Code:46224
Practice Address - Country:US
Practice Address - Phone:317-293-4123
Practice Address - Fax:317-293-1099
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006443A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice