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General NPI Number Information
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NPI Number | 1710312046
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Entity Type | Organization
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Legal Business Name | MATTHEW A HUDSON, DMD, PC
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Dates
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Enumeration Date | 09/05/2013
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 132 WALNUT AVE STE B
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-7483
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Country | US
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Telephone | 970-242-5151
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Fax | 970-255-6664
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Provider Business Mailing Address
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Address Line | 132 WALNUT AVE STE B
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-7483
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Country | US
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Telephone | 970-242-5151
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Fax | 970-255-6664
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW A HUDSON
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Credential | DMD
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Telephone | 970-242-5151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9703
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License Number State | CO
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