Provider Demographics
NPI:1184710089
Name:WERNER, JUDSON A (DDS)
Entity type:Individual
Prefix:DR
First Name:JUDSON
Middle Name:A
Last Name:WERNER
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 1:2150 112TH AVE NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-2975
Mailing Address - Country:US
Mailing Address - Phone:425-454-2892
Mailing Address - Fax:425-451-8266
Practice Address - Street 1:2150 112TH AVE NE
Practice Address - Street 2:SUITE B
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2975
Practice Address - Country:US
Practice Address - Phone:425-454-2892
Practice Address - Fax:425-451-8266
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000097041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice