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General NPI Number Information
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NPI Number | 1275526972
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Entity Type | Individual
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Provider Name | KEVIN EDWARD HUDSON D.D.S., R.N.
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Gender | Male
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 01/04/2025
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Provider Practice Location Address
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Address Line | 4207 TIETON DR
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City | YAKIMA
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State | WA
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Zip | 98908-3347
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Country | US
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Telephone | 509-965-8911
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Fax |
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Provider Business Mailing Address
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Address Line | 304 N 99TH AVE
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City | YAKIMA
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State | WA
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Zip | 98908-9505
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Country | US
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Telephone | 619-733-0169
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DE00009590
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License Number State | WA
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