NPIMap

Individual provider Active NPI

Lisa M Judge, D.D.S

  • General Practice Dentistry
  • Avondale, LA
National Provider Identifier
1013172659
Registry record updated Jan 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4430 Issued in LA
Practice address
3932 Highway 90 W
Avondale, LA 70094-2648
Phone
(504) 436-2223
NPI assigned
Jul 23, 2008
Last updated
Jan 19, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 19, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN011180 GA
General Practice Dentistry 1223G0001X 4430 LA Primary

Addresses

Primary practice location

3932 Highway 90 W
Avondale, LA 70094-2648

Mailing address

PO Box 2490
Marrero, LA 70073-2490

Other practice location 1

1230 Powers Ferry Rd # 6
Marietta, GA 30067
Phone (770) 541-0101

Other identifiers 2

IdentifierTypeStateIssuer
000764112BMedicaidGA
1844306MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DN011180GAMDGeneral Practice Dentistry
4430LAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Judge, Lisa Maria DDS PC General Practice Past Accepting new patients

Networks

  • MS PPO C-SNP
  • TX HMO D-SNP
  • LA PPO C-SNP
  • MS PPO D-SNP

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/12324/brand/1/csg/1/fhir/r4

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674086400000",
    "number": "1013172659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2490",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "700732490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3932 HIGHWAY 90 W",
            "city": "AVONDALE",
            "state": "LA",
            "postal_code": "700942648",
            "telephone_number": "504-436-2223"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1230 Powers Ferry Rd # 6",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "30067",
            "country_code": "US",
            "telephone_number": "770-541-0101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JUDGE",
        "first_name": "LISA",
        "middle_name": "M",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-23",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN011180",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "4430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000764112B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1844306",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Avondale, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.