Provider Demographics
NPI:1609114222
Name:HUDSON, HILLARIE RYANN (DMD MSD)
Entity Type:Individual
Prefix:
First Name:HILLARIE
Middle Name:RYANN
Last Name:HUDSON
Suffix:
Gender:F
Credentials:DMD MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 N COUNTRY CLUB RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-4161
Mailing Address - Country:US
Mailing Address - Phone:217-429-7070
Mailing Address - Fax:217-429-7189
Practice Address - Street 1:2 N COUNTRY CLUB RD
Practice Address - Street 2:SUITE 1
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-4161
Practice Address - Country:US
Practice Address - Phone:217-429-7070
Practice Address - Fax:217-429-7189
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190277191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics