Provider Demographics
NPI:1518015643
Name:UDELL-MARTIN, KATHY ARLENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:ARLENE
Last Name:UDELL-MARTIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 DOGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1004
Mailing Address - Country:US
Mailing Address - Phone:973-819-5078
Mailing Address - Fax:973-731-2680
Practice Address - Street 1:110 BERGEN ST
Practice Address - Street 2:UMDNJ-NJ DENTAL SCHOOL, ROOM D-830
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2495
Practice Address - Country:US
Practice Address - Phone:973-972-4615
Practice Address - Fax:973-972-0370
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI011621001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice