Provider Demographics
NPI:1538183934
Name:MCGUIRE, JUDITH WILLETT (DMD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:WILLETT
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1966 TUTWILER AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38107-5126
Mailing Address - Country:US
Mailing Address - Phone:901-692-7586
Mailing Address - Fax:901-278-4645
Practice Address - Street 1:875 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3513
Practice Address - Country:US
Practice Address - Phone:901-448-6204
Practice Address - Fax:901-448-1371
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0087121223G0001X
TN9036122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9033OtherDENTAL LICENSE
TN308316OtherUTHSC EMPLOYEE NUMBER
GA8712OtherDENTAL LICENSE