Provider Demographics
NPI:1841078631
Name:JUDI DENTAL, PLLC
Entity type:Organization
Organization Name:JUDI DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-WAZZAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-706-3368
Mailing Address - Street 1:2909 HILLCROFT ST STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-5847
Mailing Address - Country:US
Mailing Address - Phone:713-706-3368
Mailing Address - Fax:713-706-3370
Practice Address - Street 1:2909 HILLCROFT ST STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5847
Practice Address - Country:US
Practice Address - Phone:713-706-3368
Practice Address - Fax:713-706-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty