Provider Demographics
NPI:1841362290
Name:HUDSON, HEIDI M
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:M
Last Name:HUDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W COMMERCE RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-3922
Mailing Address - Country:US
Mailing Address - Phone:248-363-5388
Mailing Address - Fax:248-363-5606
Practice Address - Street 1:415 W COMMERCE RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-3922
Practice Address - Country:US
Practice Address - Phone:248-363-5388
Practice Address - Fax:248-363-5606
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010180981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice