Healthcare Provider Details

I. General information

NPI: 1215001250
Provider Name (Legal Business Name): JAMES BRADLEY JUDAY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7815 E JEFFERSON AVE LOWER LEVEL
DETROIT MI
48214-3704
US

IV. Provider business mailing address

7815 E JEFFERSON AVE LOWER LEVEL
DETROIT MI
48214-3704
US

V. Phone/Fax

Practice location:
  • Phone: 313-499-4775
  • Fax: 313-499-4908
Mailing address:
  • Phone: 313-499-4775
  • Fax: 313-499-4908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901016645
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: