Healthcare Provider Details

I. General information

NPI: 1639201007
Provider Name (Legal Business Name): DANIEL HUDSON DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 11/27/2023
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1666 S FOREST AVE
LUVERNE AL
36049-7305
US

IV. Provider business mailing address

1666 S FOREST AVE
LUVERNE AL
36049-7305
US

V. Phone/Fax

Practice location:
  • Phone: 334-335-3697
  • Fax: 334-335-4128
Mailing address:
  • Phone: 334-335-3697
  • Fax: 334-335-4128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL COWEN HUDSON
Title or Position: OWNER
Credential: AO
Phone: 334-335-3697