Healthcare Provider Details

I. General information

NPI: 1598803348
Provider Name (Legal Business Name): HEATHER T HUDKINS DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 E SUNSHINE ST STE E10
SPRINGFIELD MO
65804-1237
US

IV. Provider business mailing address

1531 E SUNSHINE ST STE E10
SPRINGFIELD MO
65804-1237
US

V. Phone/Fax

Practice location:
  • Phone: 417-883-5866
  • Fax: 417-883-5898
Mailing address:
  • Phone: 417-883-5866
  • Fax: 417-883-5898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2001013203
License Number StateMO

VIII. Authorized Official

Name: MR. ERIC M HUDKINS
Title or Position: VICE PRESIDENT
Credential:
Phone: 417-883-5866