Provider Demographics
NPI:1609154855
Name:EUGENE, JUDITH THEOMAT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:THEOMAT
Last Name:EUGENE
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 1:2250 CHAMPLAIN STREET SW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2618
Mailing Address - Country:US
Mailing Address - Phone:202-232-9022
Mailing Address - Fax:202-232-8494
Practice Address - Street 1:1500 GALEN ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-4936
Practice Address - Country:US
Practice Address - Phone:202-610-7160
Practice Address - Fax:202-610-7164
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10011351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice