Provider Demographics
NPI:1922020379
Name:HUDSON, JOHN W (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:HUDSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:W
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1930 ALCOA HWY
Mailing Address - Street 2:STE 335
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1500
Mailing Address - Country:US
Mailing Address - Phone:865-544-9021
Mailing Address - Fax:865-544-9565
Practice Address - Street 1:1930 ALCOA HWY
Practice Address - Street 2:STE 335
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1500
Practice Address - Country:US
Practice Address - Phone:865-544-9021
Practice Address - Fax:865-544-9565
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0060301223S0112X, 204E00000X
MI2901014026204E00000X
CACERTIFICATE207PE0005X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3224723Medicaid
TN199845OtherCIGNA DENTAL DMO OFFC 2
TN199846OtherCIGNA DENTAL DMO OFFC 3
TNDS006030OtherLICENSE
UT732021OtherDENTAL BEN. PROV. OFFC 1
KY64777451OtherKENTUCKY MEDICAID
UT732022OtherDENTAL BEN. PROV. OFFC 2
TNTN0103OtherAMERICHOICE TENNCARE O-2
TN1211270OtherCIGNA DENTAL DMO OFFC 1
TN199845OtherCIGNA DENTAL PPO OFFC 2
TN621199959OtherCIGNA DENTAL PPO
UT732023OtherDENTAL BEN. PROV. OFFC 3
0015837OtherBLUE CROSS BLUE SHIELD
TN199846OtherCIGNA DENTAL PPO OFFC3
TNTN0102OtherAMERICHOICE TENNCARE O-1
IA0005113OtherASSURANT EMPLOYEE BENEFIT
TNTN0104OtherAMERICHOICE TENNCARE O-3
KY64777451OtherKENTUCKY MEDICAID