Provider Demographics
NPI:1679629828
Name:JUDD DENTISTRY PA
Entity Type:Organization
Organization Name:JUDD DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:PATRICE BRUNEY
Authorized Official - Last Name:JUDD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:410-884-5833
Mailing Address - Street 1:8860 COLUMBIA 100 PKWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2195
Mailing Address - Country:US
Mailing Address - Phone:410-884-5833
Mailing Address - Fax:410-884-5836
Practice Address - Street 1:8860 COLUMBIA 100 PKWY
Practice Address - Street 2:SUITE 106
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2195
Practice Address - Country:US
Practice Address - Phone:410-884-5833
Practice Address - Fax:410-884-5836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-27
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD133891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty