Provider Demographics
NPI:1386771905
Name:HULBERT-ANDERSON, JUDY (DDS)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:
Last Name:HULBERT-ANDERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PASEO DEL CANON W # B
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6394
Mailing Address - Country:US
Mailing Address - Phone:505-758-7337
Mailing Address - Fax:505-751-0348
Practice Address - Street 1:101 WEST COAST RD.
Practice Address - Street 2:
Practice Address - City:REDWAY
Practice Address - State:CA
Practice Address - Zip Code:95560-0769
Practice Address - Country:US
Practice Address - Phone:707-923-4313
Practice Address - Fax:707-923-2590
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD17871223G0001X
CA540791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMDD1787OtherLICENSE NUMBER
CA54079OtherDENTAL BOARD OF CA
NM74-2821474OtherTIN NUMBER