Provider Demographics
NPI:1972643179
Name:HENRY J UDOUJ, D.D.S., P.A.
Entity Type:Organization
Organization Name:HENRY J UDOUJ, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:UDOUJ
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-782-3021
Mailing Address - Street 1:2101 DALLAS ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-6823
Mailing Address - Country:US
Mailing Address - Phone:479-782-3021
Mailing Address - Fax:479-782-2667
Practice Address - Street 1:2101 DALLAS ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-6823
Practice Address - Country:US
Practice Address - Phone:479-782-3021
Practice Address - Fax:479-782-2667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty