1952522278 NPI number — DR. ARWINDER SINGH JUDGE DDS

Table of content: DR. ARWINDER SINGH JUDGE DDS (NPI 1952522278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952522278 NPI number — DR. ARWINDER SINGH JUDGE DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JUDGE
Provider First Name:
ARWINDER
Provider Middle Name:
SINGH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952522278
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5104 WATERFORD WOODWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-343-1612
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GREAT LAKES DENTAL SERVICES, PC
Provider Second Line Business Practice Location Address:
10 GEORGE ST
Provider Business Practice Location Address City Name:
OSWEGO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-343-1612
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  046192 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01602299 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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