Provider Demographics
NPI:1720137490
Name:HUDSON, SCOTT CAMERON (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:CAMERON
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 1:158 VICTORIA STA
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-1467
Mailing Address - Country:US
Mailing Address - Phone:760-867-6866
Mailing Address - Fax:
Practice Address - Street 1:3509 BAKER RD NW STE 401
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-6305
Practice Address - Country:US
Practice Address - Phone:770-917-8943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA311271223G0001X
GADN0157261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice