Provider Demographics
NPI:1770682460
Name:HUDGINS, CHARLES H (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:H
Last Name:HUDGINS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 BLANDING BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-5788
Mailing Address - Country:US
Mailing Address - Phone:904-276-0000
Mailing Address - Fax:904-276-0050
Practice Address - Street 1:767 BLANDING BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-5788
Practice Address - Country:US
Practice Address - Phone:904-276-0000
Practice Address - Fax:904-276-0050
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8546122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice