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General NPI Number Information
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NPI Number | 1164448320
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Entity Type | Organization
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Legal Business Name | S. CLINT HUDSON, D.M.D., M.D., L.L.C.
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 09/03/2013
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Provider Practice Location Address
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Address Line | 2317 WHITESBURG DR S
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City | HUNTSVILLE
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State | AL
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Zip | 35801-3819
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Country | US
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Telephone | 256-533-1282
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Fax | 256-533-1288
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Provider Business Mailing Address
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Address Line | 2317 WHITESBURG DR S
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City | HUNTSVILLE
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State | AL
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Zip | 35801-3819
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Country | US
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Telephone | 256-533-1282
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Fax | 256-533-1288
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Authorized Official
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Title or Position | OWNER
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Name | S CLINT HUDSON
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Credential | DMD, MD
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Telephone | 256-533-1282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 5051
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License Number State | AL
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