Provider Demographics
NPI:1679579890
Name:HUDSON, JAMES R (D,D,S,)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:HUDSON
Suffix:
Gender:M
Credentials:D,D,S,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 PLAZA DR
Mailing Address - Street 2:STE K
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-2922
Mailing Address - Country:US
Mailing Address - Phone:812-372-8386
Mailing Address - Fax:
Practice Address - Street 1:540 PLAZA DR
Practice Address - Street 2:STE K
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-2922
Practice Address - Country:US
Practice Address - Phone:812-372-8386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2010-12-02
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
IN12006201A1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics