Provider Demographics
NPI:1427725019
Name:HUDSON, REBECCA J (DMD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:J
Last Name:HUDSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18040 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1606
Mailing Address - Country:US
Mailing Address - Phone:708-798-6868
Mailing Address - Fax:
Practice Address - Street 1:18040 PARK AVE
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1606
Practice Address - Country:US
Practice Address - Phone:708-798-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019033389122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist