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General NPI Number Information
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NPI Number | 1063685501
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Entity Type | Organization
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Legal Business Name | ROY A HUDSON III DDS VANCE AVENUE DENTAL CLINIC
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Dates
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Enumeration Date | 04/04/2008
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 516 VANCE AVE
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City | MEMPHIS
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State | TN
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Zip | 38126-2117
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Country | US
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Telephone | 901-526-4442
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Fax | 901-526-8523
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Provider Business Mailing Address
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Address Line | 516 VANCE AVE
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City | MEMPHIS
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State | TN
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Zip | 38126-2117
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Country | US
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Telephone | 901-526-4442
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Fax | 901-526-8523
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. ROY ADRAIN HUDSON III
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Credential | DDS
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Telephone | 901-526-4442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS0000007059
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License Number State | TN
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