Provider Demographics
NPI:1801064399
Name:BUDO, JAN CHRISTIAN (RDH)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:CHRISTIAN
Last Name:BUDO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 837
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96555
Mailing Address - Country:US
Mailing Address - Phone:805-355-2493
Mailing Address - Fax:805-355-2174
Practice Address - Street 1:BOX 1700
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96555
Practice Address - Country:US
Practice Address - Phone:805-355-2165
Practice Address - Fax:805-355-2174
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2147124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist