Healthcare Provider Details

I. General information

NPI: 1588728646
Provider Name (Legal Business Name): JUDD ELLIS PARTRIDGE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4775 W DAYBREAK PKWY STE 104
SOUTH JORDAN UT
84009-5139
US

IV. Provider business mailing address

4775 W DAYBREAK PKWY STE 104
SOUTH JORDAN UT
84009-5139
US

V. Phone/Fax

Practice location:
  • Phone: 801-280-5535
  • Fax: 801-987-3601
Mailing address:
  • Phone: 801-280-5535
  • Fax: 801-987-3601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD-3980
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: