Provider Demographics
NPI:1740395441
Name:HUDKINS, HEATHER T (DDS)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:T
Last Name:HUDKINS
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 E SUNSHINE ST STE E10
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1237
Mailing Address - Country:US
Mailing Address - Phone:417-883-5866
Mailing Address - Fax:417-883-5898
Practice Address - Street 1:714 HWY 248
Practice Address - Street 2:515
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616
Practice Address - Country:US
Practice Address - Phone:417-883-5866
Practice Address - Fax:417-883-5898
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001013203122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO405284514Medicaid