Provider Demographics
NPI:1689089500
Name:JUDD, BRIAN (DDS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:JUDD
Suffix:
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 1:16 HAMPTON VILLAGE PLZ STE 225
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2109
Mailing Address - Country:US
Mailing Address - Phone:314-916-5757
Mailing Address - Fax:314-916-5758
Practice Address - Street 1:16 HAMPTON VILLAGE PLZ STE 225
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2109
Practice Address - Country:US
Practice Address - Phone:314-916-5757
Practice Address - Fax:314-916-5758
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190240721223E0200X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics