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General NPI Number Information
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NPI Number | 1093606915
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Entity Type | Individual
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Provider Name | JUDY MAXIMOUS
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Gender | Female
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Dates
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Enumeration Date | 07/10/2025
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 1515 PROSPECT AVE UNIT C
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City | PLACENTIA
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State | CA
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Zip | 92870-3826
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Country | US
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Telephone | 631-748-4630
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Fax | 631-748-4630
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Provider Business Mailing Address
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Address Line | 1515 PROSPECT AVE UNIT C
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City | PLACENTIA
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State | CA
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Zip | 92870-3826
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Country | US
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Telephone | 631-748-4630
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Fax | 631-748-4630
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 37308
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License Number State | CA
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