MEDICARE: DR. LELAND R JUDD DDS

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	1223G0001X	General Practice Dentistry	4278-015	WI

General Provider Information

NPI Number	:	1710960745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LELAND R JUDD DDS

Provider Business Mailing Address
First Line	:	4831 LARSON BEACH RD
Second Line	:
City	:	MC FARLAND
State	:	WI
Zip	:	53558-8735
Country	:	US
Telephone Number	:	608-838-9731
Fax Number	:	608-838-9716

Provider Business Practice Location Address
First Line	:	4831 LARSON BEACH RD
Second Line	:
City	:	MC FARLAND
State	:	WI
Zip	:	53558-8735
Country	:	US
Telephone Number	:	608-838-9731
Fax Number	:	608-838-9716

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	07/08/2007

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