MEDICARE: DR. HUDSON GUY MOTLEY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5564-015	WI

General Provider Information

NPI Number	:	1316917370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HUDSON GUY MOTLEY DDS

Provider Business Mailing Address
First Line	:	378 E RANNEY AVE
Second Line	:
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-4133
Country	:	US
Telephone Number	:	847-955-9434
Fax Number	:	847-688-6259

Provider Business Practice Location Address
First Line	:	2410 SAMPSON ST
Second Line	:	DENTAL CLINIC
City	:	GREAT LAKES
State	:	IL
Zip	:	60088-2942
Country	:	US
Telephone Number	:	847-688-3620
Fax Number	:	847-688-6259

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	07/08/2007

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