Provider Demographics
NPI:1265642045
Name:MANEELY, JUDITH LEE (RDH, EFDA)
Entity Type:Individual
Prefix:MISS
First Name:JUDITH
Middle Name:LEE
Last Name:MANEELY
Suffix:
Gender:F
Credentials:RDH, EFDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 E 174TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-3107
Mailing Address - Country:US
Mailing Address - Phone:216-383-1737
Mailing Address - Fax:216-383-1737
Practice Address - Street 1:3456 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44118-1405
Practice Address - Country:US
Practice Address - Phone:440-442-3800
Practice Address - Fax:440-442-3800
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3388124Q00000X
TX4404124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist