Provider Demographics
NPI:1417717034
Name:JUDLEY ALPHONSE DMD PLLC
Entity Type:Organization
Organization Name:JUDLEY ALPHONSE DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALPHONSE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-668-0244
Mailing Address - Street 1:101 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2508
Mailing Address - Country:US
Mailing Address - Phone:603-668-0244
Mailing Address - Fax:603-623-8941
Practice Address - Street 1:101 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2508
Practice Address - Country:US
Practice Address - Phone:603-668-0244
Practice Address - Fax:603-623-8941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty