Provider Demographics
NPI:1457376246
Name:UDOUJ, STAN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:STAN
Middle Name:M
Last Name:UDOUJ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4608
Mailing Address - Country:US
Mailing Address - Phone:479-782-3005
Mailing Address - Fax:479-494-7490
Practice Address - Street 1:520 S 14TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4608
Practice Address - Country:US
Practice Address - Phone:479-782-3005
Practice Address - Fax:479-494-7490
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR27251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice