Ryan W Judd, DMD

Primary specialty

Dental AnesthesiologyTaxonomy code 1223D0004X

License

D4613 Issued in ID

Practice address

3245 S Brandenberg Ave
Eagle, ID 83616-4413

Phone

(503) 679-9797

NPI assigned

Nov 9, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Eagle Anesthesia & Oral Surgery PLLC

  • Dental Anesthesiology
  • Boise, ID
  • NPI 1972333565
  NPD Authorized official
• Idaho Dental Anesthesia PLLC

  • Dental Anesthesiology
  • Meridian, ID
  • NPI 1629470141
  NPD Authorized official
• Magic Valley Dental Anesthesia PLLC

  • Dental Anesthesiology
  • Twin Falls, ID
  • NPI 1346824422
  NPD Authorized official

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661817600000",
    "number": "1609946078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37 W ARCHERFIELD ST STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836466587",
            "telephone_number": "208-391-2894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3245 S BRANDENBERG AVE",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836164413",
            "telephone_number": "503-679-9797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUDD",
        "first_name": "RYAN",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "ID",
            "license": "D4613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Judith L. Johnson, APRN, CNS
• Mark David Johnston, PHARMD
• Trisha Jones, PT
• Jennifer Jordan, PSYD
• Gavin Christopher Jorns, D.C.
• Samuel James Jurca, DO
• Bruce Kahl, ATHLETIC TRAINER
• Dawn Marie Kangas, LPC
• Kara Maria Katzenmeyer, OTR/L
• Chandler Kaye Kauffman, OD

• Dental Anesthesiology in Eagle, ID
• Providers in Eagle, ID by specialty
• Dental Anesthesiology in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2022; 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.