Provider Demographics
NPI:1275526972
Name:HUDSON, KEVIN EDWARD (DDS, RN)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:EDWARD
Last Name:HUDSON
Suffix:
Gender:M
Credentials:DDS, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 N 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-9505
Mailing Address - Country:US
Mailing Address - Phone:619-733-0169
Mailing Address - Fax:
Practice Address - Street 1:4207 TIETON DR
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3347
Practice Address - Country:US
Practice Address - Phone:509-965-8911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000095901223S0112X
IDD-3737122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery