Provider Demographics
NPI:1568562809
Name:HUDSON, GARRY D (DDS)
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:D
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 1:7146 SR 247
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72858-8891
Mailing Address - Country:US
Mailing Address - Phone:479-858-7382
Mailing Address - Fax:479-858-7323
Practice Address - Street 1:7146 SR 247
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72858-8891
Practice Address - Country:US
Practice Address - Phone:479-858-7382
Practice Address - Fax:479-858-7323
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2123122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist