Provider Demographics
NPI:1598100034
Name:HUDSON, DANIEL COWEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:COWEN
Last Name:HUDSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1666 S FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:AL
Mailing Address - Zip Code:36049-7305
Mailing Address - Country:US
Mailing Address - Phone:334-335-3697
Mailing Address - Fax:334-335-4128
Practice Address - Street 1:1666 S FOREST AVE
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:AL
Practice Address - Zip Code:36049-7305
Practice Address - Country:US
Practice Address - Phone:334-335-3697
Practice Address - Fax:334-335-4128
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4934122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL06053OtherBLUE CROSS BLUE SHIELD OF ALABAMA
920212OtherUNITED CONCORDIA