Provider Demographics
NPI:1932305422
Name:AUSTIN, JUDITH LORRAINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:LORRAINE
Last Name:AUSTIN
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 1:12027 MONTROSE VILLAGE TER
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4162
Mailing Address - Country:US
Mailing Address - Phone:301-881-5500
Mailing Address - Fax:301-881-5517
Practice Address - Street 1:11400 ROCKVILLE PIKE STE 510
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3041
Practice Address - Country:US
Practice Address - Phone:301-881-5500
Practice Address - Fax:301-881-5517
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD90921223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics