Provider Demographics
NPI:1740395441
Name:HUDKINS, HEATHER T (DDS)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:T
Last Name:HUDKINS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 E SUNSHINE ST STE E10
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1237
Mailing Address - Country:US
Mailing Address - Phone:417-883-5866
Mailing Address - Fax:417-883-5898
Practice Address - Street 1:1531 E SUNSHINE ST STE E10
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1237
Practice Address - Country:US
Practice Address - Phone:417-883-5866
Practice Address - Fax:417-883-5898
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010132031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO405284514Medicaid