Provider Demographics
NPI:1013202720
Name:BUDD, JODI A (RDH, LAP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:A
Last Name:BUDD
Suffix:
Gender:F
Credentials:RDH, LAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-0132
Mailing Address - Country:US
Mailing Address - Phone:541-782-8242
Mailing Address - Fax:
Practice Address - Street 1:47815 HIGHWAY 58
Practice Address - Street 2:
Practice Address - City:OAKRIDGE
Practice Address - State:OR
Practice Address - Zip Code:97463-9572
Practice Address - Country:US
Practice Address - Phone:541-782-8304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH2795124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist