Provider Demographics
NPI:1386802627
Name:GILLARD, JUDY TAMAR (DDS)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:TAMAR
Last Name:GILLARD
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 1:28291 EL SUR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4423
Mailing Address - Country:US
Mailing Address - Phone:408-607-4909
Mailing Address - Fax:
Practice Address - Street 1:2515 EASTBLUFF DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3504
Practice Address - Country:US
Practice Address - Phone:949-640-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
CA570941223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center