=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235221235
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LLOYD A HUDSON DDS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7316 E 91ST ST
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74133-6016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-491-9996
-----------------------------------------------------
Fax | 918-491-6999
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7316 E 91ST ST
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74133-6016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-491-9996
-----------------------------------------------------
Fax | 918-491-6999
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 5352
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------