Organization
IDAHO DENTAL ANESTHESIA PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN W JUDD DMD (DENTIST ANESTHESIOLOGIST)
(503) 679-9797
Entity
Organization
Contact information
Practice address
37 W ARCHERFIELD ST STE 100, MERIDIAN, ID 83646-6587
(208) 391-2894
Mailing address
37 W ARCHERFIELD ST STE 100, MERIDIAN, ID 83646-6587
(208) 391-2894
Taxonomy
Speciality
Code
Description
License number
State
1223D0004X
Dental Anesthesiology
Primary
D-4613
ID
Other
Enumeration date
09/17/2014
Last updated
08/12/2020
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