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General NPI Number Information
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NPI Number | 1275294670
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Entity Type | Individual
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Provider Name | DAVID HARRISON HUDSON DMD MS
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Gender | Male
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Dates
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Enumeration Date | 01/07/2022
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Last Update Date | 01/07/2022
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Provider Practice Location Address
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Address Line | 997 CLOCK TOWER DR
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City | SPRINGFIELD
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State | IL
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Zip | 62704-1301
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Country | US
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Telephone | 217-546-9600
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Fax |
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Provider Business Mailing Address
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Address Line | 997 CLOCK TOWER DR
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City | SPRINGFIELD
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State | IL
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Zip | 62704-1301
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Country | US
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Telephone | 217-546-9600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 021.003156
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License Number State | IL
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