Elliott Hodges Dudley, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

9633 Issued in TN

Practice address

1119 Vann Dr
Jackson, TN 38305-6098

Phone

(731) 300-2447

NPI assigned

Aug 27, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Networks

• MS PPO D-SNP
• MS PPO C-SNP

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• E H Dudley, DDS, PLLC

  dba Aspen Dental

  • General Practice Dentistry
  • Jackson, TN
  • NPI 1043676604
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427932800000",
    "number": "1023265493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1119 VANN DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383056098",
            "telephone_number": "731-300-2447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1119 VANN DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383056098",
            "telephone_number": "731-300-2447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDLEY",
        "first_name": "ELLIOTT",
        "middle_name": "HODGES",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-27",
        "last_updated": "2015-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "9633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dr. Mark H Crowell PLLC
• Catherine Mary Draper, MS, RD, LDN
• Jeremy Michael Draper, MD
• Richard Key Drewery, PHD
• Amy P Driscoll, PT
• Miranda Dianne Dudley, LMSW
• Kristi Deanne Duffield, PA-C
• Joseph Raleigh Duke III, PA-C
• Sarah Wilhite Duke, SLP
• Caitlyn Manning Dulaney

• Dentist in Jackson, TN
• Providers in Jackson, TN by specialty
• Dentist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.