Healthcare Provider Details

I. General information

NPI: 1427193705
Provider Name (Legal Business Name): JUDITH JER VUE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7260 E SOUTHGATE DR SUITE B
SACRAMENTO CA
95823-2609
US

IV. Provider business mailing address

7260 E SOUTHGATE DR SUITE B
SACRAMENTO CA
95823-2609
US

V. Phone/Fax

Practice location:
  • Phone: 916-429-1325
  • Fax: 916-429-1326
Mailing address:
  • Phone: 916-429-1325
  • Fax: 916-429-1326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number49242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: