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General NPI Number Information
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NPI Number | 1679579890
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Entity Type | Individual
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Provider Name | JAMES R. HUDSON D,D,S,
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Gender | Male
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 540 PLAZA DR STE K
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City | COLUMBUS
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State | IN
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Zip | 47201-2922
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Country | US
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Telephone | 812-372-8386
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Fax |
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Provider Business Mailing Address
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Address Line | 540 PLAZA DR STE K
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City | COLUMBUS
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State | IN
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Zip | 47201-2922
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Country | US
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Telephone | 812-372-8386
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 12006201A
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License Number State | IN
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