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General NPI Number Information
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NPI Number | 1114329695
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Entity Type | Individual
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Provider Name | NOAH JUEDES D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/16/2014
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Last Update Date | 09/16/2014
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Provider Practice Location Address
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Address Line | 5510 MEDICAL CIR ODANA HILLS DENTAL
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City | MADISON
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State | WI
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Zip | 53719-1239
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Country | US
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Telephone | 608-274-5510
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Fax |
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Provider Business Mailing Address
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Address Line | 612 2ND AVE E
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City | WASHBURN
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State | WI
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Zip | 54891-9301
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Country | US
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Telephone | 352-284-4082
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 7283-15
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License Number State | WI
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