Provider Demographics
NPI:1568494235
Name:JOHN A HUDEC DENTAL ASSOCIATES INC
Entity Type:Organization
Organization Name:JOHN A HUDEC DENTAL ASSOCIATES INC
Other - Org Name:HUDEC DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUDEC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:216-398-8900
Mailing Address - Street 1:1730 WEST 25TH STREET
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-3108
Mailing Address - Country:US
Mailing Address - Phone:216-861-5330
Mailing Address - Fax:216-623-7596
Practice Address - Street 1:1730 WEST 25TH STREET
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3108
Practice Address - Country:US
Practice Address - Phone:216-861-5330
Practice Address - Fax:216-623-7596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0578549Medicaid