Provider Demographics
NPI:1609946078
Name:JUDD, RYAN W (DMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:W
Last Name:JUDD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 W ARCHERFIELD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6587
Mailing Address - Country:US
Mailing Address - Phone:208-391-2894
Mailing Address - Fax:
Practice Address - Street 1:3245 S BRANDENBERG AVE
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-4413
Practice Address - Country:US
Practice Address - Phone:503-679-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD46131223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist