Provider Demographics
NPI:1932325677
Name:GARY W. HUDSON, DMD, MD, PC
Entity Type:Organization
Organization Name:GARY W. HUDSON, DMD, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD
Authorized Official - Phone:256-882-7873
Mailing Address - Street 1:1105 EAGLETREE LN SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6447
Mailing Address - Country:US
Mailing Address - Phone:256-882-7873
Mailing Address - Fax:256-882-7874
Practice Address - Street 1:1105 EAGLETREE LN SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6447
Practice Address - Country:US
Practice Address - Phone:256-882-7873
Practice Address - Fax:256-882-7874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL36771223S0112X
AL12133204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Not Answered204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51000927OtherBLUE CROSS BLUE SHIELD AL
AL720892OtherUNITED CONCORDIA
AL=========OtherGUARDIAN
AL=========OtherDELTA DENTAL
AL=========OtherSOUTHLAND
AL720892OtherUNITED CONCORDIA
AL=========OtherPRINCIPAL
AL=========OtherNAMCI
AL=========OtherAMERITAS
AL=========OtherAETNA
AL=========OtherJARDINES
AL=========OtherCIGNA
AL51000927OtherBLUE CROSS BLUE SHIELD AL
AL=========OtherWASHINGTON DENTAL
ALC70141Medicare UPIN