Provider Demographics
NPI:1902958754
Name:JUDALENA, JOY M (DDS)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:M
Last Name:JUDALENA
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 1:4920 S 30TH ST
Mailing Address - Street 2:#103
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-1590
Mailing Address - Country:US
Mailing Address - Phone:402-932-7204
Mailing Address - Fax:402-952-1020
Practice Address - Street 1:4920 S 30TH ST
Practice Address - Street 2:#103
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-1590
Practice Address - Country:US
Practice Address - Phone:402-932-7204
Practice Address - Fax:402-952-1020
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE63981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice