Provider Demographics
NPI:1598803348
Name:HEATHER T HUDKINS DDS PC
Entity Type:Organization
Organization Name:HEATHER T HUDKINS DDS PC
Other - Org Name:SMILE ZONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUDKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-883-5866
Mailing Address - Street 1:1531 E SUNSHINE ST STE E10
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1237
Mailing Address - Country:US
Mailing Address - Phone:417-883-5866
Mailing Address - Fax:417-883-5898
Practice Address - Street 1:1531 E SUNSHINE ST STE E10
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1237
Practice Address - Country:US
Practice Address - Phone:417-883-5866
Practice Address - Fax:417-883-5898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010132031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty