Individual
DR. JACOB JUDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7721 W 21ST ST N, WICHITA, KS 67205-1737
(316) 681-1099
(316) 613-2417
Mailing address
652 W 163RD ST APT 28, NEW YORK, NY 10032-4515
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
22DI02950800
NJ
122300000X
Dentist
62079
KS
1223E0200X
Endodontics
Primary
929
KS
Other
Enumeration date
07/25/2023
Last updated
07/16/2024
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