Provider Demographics
NPI:1679613673
Name:WEST, E JUDD JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:E
Middle Name:JUDD
Last Name:WEST
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4687 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3822
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3860 JACKSON AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1956
Practice Address - Country:US
Practice Address - Phone:801-627-0420
Practice Address - Fax:801-627-0421
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13594199221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice