Provider Demographics
NPI:1114059193
Name:BOOTHBY, JUDITH M (RDHAP, BS)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:M
Last Name:BOOTHBY
Suffix:
Gender:F
Credentials:RDHAP, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8139 SUNSET AVE
Mailing Address - Street 2:#105
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-5131
Mailing Address - Country:US
Mailing Address - Phone:916-988-9767
Mailing Address - Fax:916-989-1026
Practice Address - Street 1:8139 SUNSET AVE
Practice Address - Street 2:#105
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-5131
Practice Address - Country:US
Practice Address - Phone:916-988-9767
Practice Address - Fax:916-989-1026
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP #1124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist