Michael Hudson, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.033306 Issued in IL

Practice address

1811 Lindenwood Ave
Edwardsville, IL 62025-2580

Phone

(618) 659-0456

NPI assigned

Jul 8, 2021

Sex

Male

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Edwardsville Family Dentist

  • Dental Clinic/Center
  • Edwardsville, IL
  • NPI 1063899417
  NPD

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

{
    "created_epoch": "1625702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625702400000",
    "number": "1114598208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2424 S 9TH ST APT 310",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631044720",
            "telephone_number": "217-361-7888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 LINDENWOOD AVE",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620252580",
            "telephone_number": "618-659-0456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDSON",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-08",
        "last_updated": "2021-07-08",
        "certification_date": "2021-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.033306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sophia Louise Howard, BCBA, LBA
• Micah Howell, PHARMD
• Mei Huang, M.D.
• Maia Huddleston
• Austin Allen Hudson
• Claudia Hulsey
• Ozzie Rene Hunter
• Kendra Hutchens
• Natalie J. Hutchison, O.D.
• HW Holdings

• General Practice Dentistry in Edwardsville, IL
• Providers in Edwardsville, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.