Healthcare Provider Details

I. General information

NPI: 1275526972
Provider Name (Legal Business Name): KEVIN EDWARD HUDSON D.D.S., R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6351 W RIO GRANDE AVE
KENNEWICK WA
99336-7634
US

IV. Provider business mailing address

PO BOX 190
TOPPENISH WA
98948-0190
US

V. Phone/Fax

Practice location:
  • Phone: 509-579-5830
  • Fax:
Mailing address:
  • Phone: 509-865-2395
  • Fax: 509-865-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDENT.DE.00009590
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: