Provider Demographics
NPI:1891950440
Name:HUDSON, JOSHUA EZEKIEL (DDS)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:EZEKIEL
Last Name:HUDSON
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 1:3775 SWEETGUM ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5119
Mailing Address - Country:US
Mailing Address - Phone:248-250-4272
Mailing Address - Fax:
Practice Address - Street 1:900 MAIN ST # A
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-4063
Practice Address - Country:US
Practice Address - Phone:843-488-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4503122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist