Provider Demographics
NPI:1659721819
Name:HUDSON, AMANDA (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 1ST AVE N
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-4213
Mailing Address - Country:US
Mailing Address - Phone:205-623-4455
Mailing Address - Fax:205-415-1398
Practice Address - Street 1:2320 7TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-3207
Practice Address - Country:US
Practice Address - Phone:205-251-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6306122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist