Provider Demographics
NPI:1912223777
Name:RICK JUDE, DMD, PS
Entity Type:Organization
Organization Name:RICK JUDE, DMD, PS
Other - Org Name:ADVANTAGE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:JUDE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-438-0711
Mailing Address - Street 1:344 CLEVELAND AVE SE
Mailing Address - Street 2:SUITE H
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3342
Mailing Address - Country:US
Mailing Address - Phone:360-438-0711
Mailing Address - Fax:360-438-9444
Practice Address - Street 1:344 CLEVELAND AVE SE
Practice Address - Street 2:SUITE H
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-3342
Practice Address - Country:US
Practice Address - Phone:360-438-0711
Practice Address - Fax:360-438-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602955081261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental