Healthcare Provider Details

I. General information

NPI: 1386771905
Provider Name (Legal Business Name): JUDY HULBERT-ANDERSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WEST COAST RD.
REDWAY CA
95560-0769
US

IV. Provider business mailing address

105 PASEO DEL CANON W # B
TAOS NM
87571-6394
US

V. Phone/Fax

Practice location:
  • Phone: 707-923-4313
  • Fax: 707-923-2590
Mailing address:
  • Phone: 505-758-7337
  • Fax: 505-751-0348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDD1787
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number54079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: