Provider Demographics
NPI:1518960517
Name:WARREN, JUDY WOODLIEF (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:WOODLIEF
Last Name:WARREN
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 1:225 S SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224-1750
Mailing Address - Country:US
Mailing Address - Phone:517-629-6175
Mailing Address - Fax:517-629-9197
Practice Address - Street 1:225 S SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-1750
Practice Address - Country:US
Practice Address - Phone:517-629-6175
Practice Address - Fax:517-629-9197
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI147761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice