Provider Demographics
NPI:1639159320
Name:JUDI, GEOFF DOUGLAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:GEOFF
Middle Name:DOUGLAS
Last Name:JUDI
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 1:1667 COCHRANE CIR BLDG 7495
Mailing Address - Street 2:
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4603
Mailing Address - Country:US
Mailing Address - Phone:719-526-2200
Mailing Address - Fax:719-524-1204
Practice Address - Street 1:2356 QUINN ST, BLDG 2356
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913
Practice Address - Country:US
Practice Address - Phone:719-526-2200
Practice Address - Fax:719-524-1204
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8259122300000X
CODEN-104261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist