Individual
LACEY M HUDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
600 NE 8TH ST STE 300, GRESHAM, OR 97030-7318
(503) 907-4233
Mailing address
1450 SW 31ST ST, GRESHAM, OR 97080-9610
(503) 907-4233
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
123433
OR
Other
Enumeration date
07/01/2020
Last updated
07/01/2020
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