MEDICARE: DR. JUDD ELLIS PARTRIDGE D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	D-3980	ID

General Provider Information

NPI Number	:	1588728646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDD ELLIS PARTRIDGE D.M.D.

Provider Business Mailing Address
First Line	:	4775 W DAYBREAK PKWY STE 104
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84009-5139
Country	:	US
Telephone Number	:	801-280-5535
Fax Number	:	801-987-3601

Provider Business Practice Location Address
First Line	:	4775 W DAYBREAK PKWY STE 104
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84009-5139
Country	:	US
Telephone Number	:	801-280-5535
Fax Number	:	801-987-3601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	04/30/2024

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