MEDICARE: J E JUDD DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30013023	OH

General Provider Information

NPI Number	:	1114145521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J E JUDD DDS INC

Provider Business Mailing Address
First Line	:	7800 HAMILTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-3106
Country	:	US
Telephone Number	:	513-521-6098
Fax Number	:	513-521-6099

Provider Business Practice Location Address
First Line	:	7800 HAMILTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-3106
Country	:	US
Telephone Number	:	513-521-6098
Fax Number	:	513-521-6099

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JUDSON E JUDD
Credential	:	DDS
Telephone Number	:	513-521-6098

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/22/2008

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