Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | PENDING | NC |
Y | 1223P0700X | Prosthodontist | 162432 | AK |
NPI | 1043505613 |
---|---|
Provider Name | Dr. Ashley Nicole Harris Hudson |
First Address | Jber, AK 99506-2017 |
Second Address | Jber, AK 99506-3702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2011 |
Last Update Date | 09/09/2020 |