Provider Demographics
NPI:1407835002
Name:JUDD, KEISHA PATRICE BRUNEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEISHA
Middle Name:PATRICE BRUNEY
Last Name:JUDD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KEISHA
Other - Middle Name:PATRICE
Other - Last Name:BRUNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:7015 FITZPATRICK DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3208
Mailing Address - Country:US
Mailing Address - Phone:202-812-3930
Mailing Address - Fax:
Practice Address - Street 1:8363 CHERRY LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4831
Practice Address - Country:US
Practice Address - Phone:202-812-3930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13389122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist