Provider Demographics
NPI:1528087525
Name:JUDE, RICKEY ALLEN (DMD)
Entity type:Individual
Prefix:DR
First Name:RICKEY
Middle Name:ALLEN
Last Name:JUDE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 153RD ST SE
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-2150
Mailing Address - Country:US
Mailing Address - Phone:206-817-4184
Mailing Address - Fax:
Practice Address - Street 1:1530 BELLEVUE WAY SE
Practice Address - Street 2:SUITE A
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-7110
Practice Address - Country:US
Practice Address - Phone:425-454-4963
Practice Address - Fax:425-454-0819
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 000088081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice