Healthcare Provider Details

I. General information

NPI: 1295835056
Provider Name (Legal Business Name): JUDD G HARDINA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL DENTAL ACTIVITY CREDENTIALS OFFICE CMR 402
APO AE
09180
US

IV. Provider business mailing address

LANDSTUHL DENTAL ACTIVITY CREDENTIALS OFFICE CMR 402
APO AE
09180
US

V. Phone/Fax

Practice location:
  • Phone: 011496371929130
  • Fax: 011496371929117
Mailing address:
  • Phone: 011496371929130
  • Fax: 011496371929117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number59050
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: