Individual
DR. LAFAYETTE JUDKINS SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
207 TURNER DR, REIDSVILLE, NC 27320-5726
(336) 342-0474
Mailing address
PO BOX 1110, REIDSVILLE, NC 27323-1110
(336) 342-0474
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4781
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1275632366
ORGANIZATION NPI NUMBER
NC
05
—
8994751
—
NC
01
—
94751
BLUE CROSS BLUE SHIELD
NC
Enumeration date
04/13/2007
Last updated
07/08/2007
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