Provider Demographics
NPI:1629033824
Name:HUDSON, STEVEN CLINT (DMD, MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:CLINT
Last Name:HUDSON
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:S.
Other - Middle Name:CLINT
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, MD
Mailing Address - Street 1:2317 WHITESBURG DR S
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3819
Mailing Address - Country:US
Mailing Address - Phone:256-533-1282
Mailing Address - Fax:256-533-1288
Practice Address - Street 1:2317 WHITESBURG DR S
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3819
Practice Address - Country:US
Practice Address - Phone:256-533-1282
Practice Address - Fax:256-533-1288
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL50511223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001858654OtherUNITED CONCORIDA
AL51003400OtherBLUECROSS BLUESHIELD AL
TN4129232OtherBLUECROSS BLUESHIELD TN
AL51136356OtherBLUECROSS BLUESHIELD AL
AL009937778Medicaid
AL009937778Medicaid
AL51136356OtherBLUECROSS BLUESHIELD AL