# ROY A HUDSON III DDS VANCE AVENUE DENTAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063685501
- **Authorized official:** DR. ROY ADRAIN HUDSON III DDS (OWNER/DENTIST)
- **Authorized official phone:** (901) 526-4442

## Contact information

- **Practice address:** 516 VANCE AVE, MEMPHIS, TN 38126-2117
- **Practice address phone:** (901) 526-4442
- **Practice address fax:** (901) 526-8523
- **Mailing address:** 516 VANCE AVE, MEMPHIS, TN 38126-2117
- **Mailing address phone:** (901) 526-4442
- **Mailing address fax:** (901) 526-8523

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DS0000007059 | TN | Yes |

## Other

- **Enumeration date:** 04/04/2008
- **Last updated:** 06/18/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3202421 | — | TN |