# THOMAS P JUDD DDS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801300082
- **Authorized official:** DR. THOMAS PHILLIP JUDD DDS (DENTIST)
- **Authorized official phone:** (574) 533-7621

## Contact information

- **Practice address:** 201 PRINGLE DR, GOSHEN, IN 46526-1419
- **Practice address phone:** (574) 533-7621
- **Practice address fax:** (574) 533-1072
- **Mailing address:** 201 PRINGLE DR, GOSHEN, IN 46526-1419
- **Mailing address phone:** (574) 533-7621
- **Mailing address fax:** (574) 533-1072

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 12011153A | IN | Yes |

## Other

- **Enumeration date:** 11/26/2017
- **Last updated:** 11/27/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1952565772 | INDIVIDUAL NPI | — |