Provider Demographics
NPI:1285851352
Name:JUDD, BRYAN GARDNER (DDS)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:GARDNER
Last Name:JUDD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 EUREKA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3028
Mailing Address - Country:US
Mailing Address - Phone:916-789-2552
Mailing Address - Fax:916-789-8664
Practice Address - Street 1:1603 EUREKA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3028
Practice Address - Country:US
Practice Address - Phone:916-789-2552
Practice Address - Fax:916-789-8664
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32862122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist