MEDICARE: JAMES S DEHUDY DDS PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D10653	MI

General Provider Information

NPI Number	:	1306902937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES S DEHUDY DDS PLC

Provider Business Mailing Address
First Line	:	3579 HENRY STREET SUITE 150
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49441
Country	:	US
Telephone Number	:	231-737-5500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3579 HENRY STREET
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49441
Country	:	US
Telephone Number	:	231-737-5500
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. JAMES S DEHUDY
Credential	:	DDS
Telephone Number	:	231-737-5500

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	08/22/2020

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