Provider Demographics
NPI:1720271521
Name:JUDKINS, CREED WHITE
Entity Type:Individual
Prefix:
First Name:CREED
Middle Name:WHITE
Last Name:JUDKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3111
Mailing Address - Country:US
Mailing Address - Phone:719-562-4461
Mailing Address - Fax:
Practice Address - Street 1:943 S IRBY ST
Practice Address - Street 2:SUITE A
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5238
Practice Address - Country:US
Practice Address - Phone:843-673-0075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice