Provider Demographics
NPI:1093727810
Name:RIS, JUDITH CHRISTINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:CHRISTINE
Last Name:RIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 WEST MAIN STREET
Mailing Address - Street 2:SUITE 117
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604
Mailing Address - Country:US
Mailing Address - Phone:360-666-8366
Mailing Address - Fax:360-666-7848
Practice Address - Street 1:1706 WEST MAIN STREET
Practice Address - Street 2:SUITE 117
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604
Practice Address - Country:US
Practice Address - Phone:360-666-8366
Practice Address - Fax:360-666-7848
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE7055122300000X
ORD5989122300000X
CA35892122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
791082OtherUCCI HEALTH PLAN