Healthcare Provider Details

I. General information

NPI: 1104458983
Provider Name (Legal Business Name): DR. PAGE HUDSON DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 WEST GONZALES ROAD SUITE C
OXNARD CA
93036
US

IV. Provider business mailing address

1164 NATIONAL DRIVE SUITE 40
SACRAMENTO CA
95834
US

V. Phone/Fax

Practice location:
  • Phone: 805-755-4371
  • Fax: 844-534-8464
Mailing address:
  • Phone: 916-877-7450
  • Fax: 844-534-8464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. PAGE HUDSON
Title or Position: OWNER
Credential: DDS
Phone: 916-877-7450