Provider Demographics
NPI:1316917370
Name:MOTLEY, HUDSON GUY (DDS)
Entity type:Individual
Prefix:DR
First Name:HUDSON
Middle Name:GUY
Last Name:MOTLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 E RANNEY AVE
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-4133
Mailing Address - Country:US
Mailing Address - Phone:847-955-9434
Mailing Address - Fax:847-688-6259
Practice Address - Street 1:2410 SAMPSON ST
Practice Address - Street 2:DENTAL CLINIC
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-2942
Practice Address - Country:US
Practice Address - Phone:847-688-3620
Practice Address - Fax:847-688-6259
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5564-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice