Provider Demographics
NPI:1699805390
Name:SHEA, JUDITH MAUREEN (DDS)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:MAUREEN
Last Name:SHEA
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 1:2669 CHILI AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-4153
Mailing Address - Country:US
Mailing Address - Phone:585-247-6230
Mailing Address - Fax:585-247-0580
Practice Address - Street 1:2669 CHILI AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-4153
Practice Address - Country:US
Practice Address - Phone:585-247-6230
Practice Address - Fax:585-247-0580
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0499081223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry