Jay C. Hudson, DDS
Individual provider Active NPI Dentist · Devine, TX
NPI 1396858643 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1396858643
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 19037 (TX)
- Practice address
- 1270 State Highway 173 N
Devine, TX 78016-4738 - Phone
- (830) 663-4401
- Fax
- (830) 663-5466
- NPI assigned
- Aug 17, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160414000740 | TX | Order and Referring Only - Dentist |
4880992437 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19037 | TX | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dental Health Associates of Texas, PC. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 19037 | TX | Yes |
Addresses
Primary practice location
1270 State Highway 173 N
Devine, TX 78016-4738
Mailing address
1270 State Highway 173 N
Devine, TX 78016-4738
Phone (830) 663-4401
Other providers in Devine, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.