Healthcare Provider Details

I. General information

NPI: 1295703007
Provider Name (Legal Business Name): JENNIFER JANE JUDE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 NE FIRST STREET STE 4
LITTLE FALLS MN
56345
US

IV. Provider business mailing address

119 NE FIRST STREET STE 4
LITTLE FALLS MN
56345
US

V. Phone/Fax

Practice location:
  • Phone: 320-632-6621
  • Fax: 320-632-1829
Mailing address:
  • Phone: 320-632-6621
  • Fax: 320-632-1829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD11546
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: