Provider Demographics
NPI:1740343425
Name:BORDEAUX, JUDITH MELISSA (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:MELISSA
Last Name:BORDEAUX
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 PEARL RD
Mailing Address - Street 2:D6
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-3305
Mailing Address - Country:US
Mailing Address - Phone:440-238-2332
Mailing Address - Fax:440-238-9088
Practice Address - Street 1:10850 PEARL RD
Practice Address - Street 2:D6
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-3305
Practice Address - Country:US
Practice Address - Phone:440-238-2332
Practice Address - Fax:440-238-9088
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0220181223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics