Provider Demographics
NPI:1912938895
Name:MAMBER, JUDITH SHEILAH (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:SHEILAH
Last Name:MAMBER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-5604
Mailing Address - Country:US
Mailing Address - Phone:203-237-4519
Mailing Address - Fax:
Practice Address - Street 1:23 TULIP TREE LN
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-1414
Practice Address - Country:US
Practice Address - Phone:203-387-4023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT66241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice