Provider Demographics
NPI:1710312046
Name:MATTHEW A HUDSON, DMD, PC
Entity Type:Organization
Organization Name:MATTHEW A HUDSON, DMD, PC
Other - Org Name:HUDSON FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:970-242-5151
Mailing Address - Street 1:132 WALNUT AVE STE B
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-7483
Mailing Address - Country:US
Mailing Address - Phone:970-242-5151
Mailing Address - Fax:970-255-6664
Practice Address - Street 1:132 WALNUT AVE STE B
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-7483
Practice Address - Country:US
Practice Address - Phone:970-242-5151
Practice Address - Fax:970-255-6664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9703122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty