Healthcare Provider Details

I. General information

NPI: 1104736370
Provider Name (Legal Business Name): GARY M JUDIS DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5940 CLYDE MOORE DR STE A
GROVEPORT OH
43125-2010
US

IV. Provider business mailing address

5940 CLYDE MOORE DR STE A
GROVEPORT OH
43125-2010
US

V. Phone/Fax

Practice location:
  • Phone: 614-492-1471
  • Fax: 614-492-1480
Mailing address:
  • Phone: 614-492-1471
  • Fax: 614-492-1480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. GARY JUDIS
Title or Position: OWNER
Credential: DDS
Phone: 614-492-1471