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General NPI Number Information
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NPI Number | 1932325677
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Entity Type | Organization
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Legal Business Name | GARY W. HUDSON, DMD, MD, PC
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1105 EAGLETREE LN SE
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City | HUNTSVILLE
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State | AL
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Zip | 35801-6447
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Country | US
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Telephone | 256-882-7873
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Fax | 256-882-7874
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Provider Business Mailing Address
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Address Line | 1105 EAGLETREE LN SE
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City | HUNTSVILLE
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State | AL
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Zip | 35801-6447
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Country | US
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Telephone | 256-882-7873
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Fax | 256-882-7874
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY WAYNE HUDSON
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Credential | MD, DMD
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Telephone | 256-882-7873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 12133
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 3677
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License Number State | AL
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