MEDICARE: DR. JAY C. HUDSON 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	122300000X	Dentist	19037	TX

General Provider Information

NPI Number	:	1396858643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY C. HUDSON DDS

Provider Business Mailing Address
First Line	:	1270 STATE HIGHWAY 173 N
Second Line	:
City	:	DEVINE
State	:	TX
Zip	:	78016-4738
Country	:	US
Telephone Number	:	830-663-4401
Fax Number	:	830-663-5466

Provider Business Practice Location Address
First Line	:	1270 STATE HIGHWAY 173 N
Second Line	:
City	:	DEVINE
State	:	TX
Zip	:	78016-4738
Country	:	US
Telephone Number	:	830-663-4401
Fax Number	:	830-663-5466

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/08/2007

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