Provider Demographics
NPI:1144329871
Name:UDOUJ, JOHN C (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:UDOUJ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2600 MARKET TRCE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-8681
Mailing Address - Country:US
Mailing Address - Phone:479-648-9988
Mailing Address - Fax:479-648-9996
Practice Address - Street 1:2600 MARKET TRCE
Practice Address - Street 2:SUITE B
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908-8681
Practice Address - Country:US
Practice Address - Phone:479-648-9988
Practice Address - Fax:479-648-9996
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AR27441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice