Provider Demographics
NPI:1124285820
Name:HSU, JUDY (DDS)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:
Last Name:HSU
Suffix:
Gender:F
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:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34760-0717
Mailing Address - Country:US
Mailing Address - Phone:410-608-2123
Mailing Address - Fax:
Practice Address - Street 1:301 S TUBB ST STE D2
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:FL
Practice Address - Zip Code:34760-8859
Practice Address - Country:US
Practice Address - Phone:407-347-2166
Practice Address - Fax:407-347-2566
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3701122300000X
MD13532122300000X
FL19631122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist