Healthcare Provider Details

I. General information

NPI: 1043615156
Provider Name (Legal Business Name): JUDD E PARTRIDGE DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7138 S HIGHLAND DR SUITE 211
SALT LAKE CITY UT
84121-3757
US

IV. Provider business mailing address

7138 S HIGHLAND DR SUITE 211
SALT LAKE CITY UT
84121-3757
US

V. Phone/Fax

Practice location:
  • Phone: 801-943-8703
  • Fax: 801-943-5150
Mailing address:
  • Phone: 801-943-8703
  • Fax: 801-943-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6226963
License Number StateUT

VIII. Authorized Official

Name: DR. JUDD E PARTRIDGE
Title or Position: OWNER
Credential: DMD
Phone: 801-943-8703