Provider Demographics
NPI:1104996974
Name:HUDSON, JAMES B (DDS, MS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:HUDSON
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6116 ROLLING RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1521
Mailing Address - Country:US
Mailing Address - Phone:703-451-4666
Mailing Address - Fax:
Practice Address - Street 1:6116 ROLLING RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1521
Practice Address - Country:US
Practice Address - Phone:703-451-4666
Practice Address - Fax:703-866-0741
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN85371223G0001X
NY549001223X0400X
VA04014136451223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice