Provider Demographics
NPI:1710960745
Name:JUDD, LELAND R (DDS)
Entity Type:Individual
Prefix:DR
First Name:LELAND
Middle Name:R
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 1:4831 LARSON BEACH RD
Mailing Address - Street 2:
Mailing Address - City:MC FARLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53558-8735
Mailing Address - Country:US
Mailing Address - Phone:608-838-9731
Mailing Address - Fax:608-838-9716
Practice Address - Street 1:4831 LARSON BEACH RD
Practice Address - Street 2:
Practice Address - City:MC FARLAND
Practice Address - State:WI
Practice Address - Zip Code:53558-8735
Practice Address - Country:US
Practice Address - Phone:608-838-9731
Practice Address - Fax:608-838-9716
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4278-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice