Provider Demographics
NPI:1063544658
Name:SPRINGER, JUDY VANESSA (DMD)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:VANESSA
Last Name:SPRINGER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 TURRELL AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2362
Mailing Address - Country:US
Mailing Address - Phone:973-378-5837
Mailing Address - Fax:973-571-2845
Practice Address - Street 1:969 S ORANGE AVE
Practice Address - Street 2:VAILSBURG DENTAL
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1054
Practice Address - Country:US
Practice Address - Phone:973-676-0035
Practice Address - Fax:973-676-0037
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI019696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7644205Medicaid