Healthcare Provider Details

I. General information

NPI: 1922020379
Provider Name (Legal Business Name): JOHN W HUDSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: J W HUDSON DDS

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 ALCOA HWY STE 335
KNOXVILLE TN
37920-1500
US

IV. Provider business mailing address

1930 ALCOA HWY STE 335
KNOXVILLE TN
37920-1500
US

V. Phone/Fax

Practice location:
  • Phone: 865-544-9021
  • Fax: 865-544-9565
Mailing address:
  • Phone: 865-544-9021
  • Fax: 865-544-9565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS006030
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDS006030
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number2901014026
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberCERTIFICATE
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberCERTIFICATE
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: