Provider Demographics
NPI:1598658007
Name:JUDD, KAYLA DOREEN (DDS)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:DOREEN
Last Name:JUDD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:KAYLA
Other - Middle Name:DOREEN
Other - Last Name:BURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2628 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-1803
Mailing Address - Country:US
Mailing Address - Phone:765-825-2941
Mailing Address - Fax:765-827-5796
Practice Address - Street 1:2628 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-1803
Practice Address - Country:US
Practice Address - Phone:765-825-2941
Practice Address - Fax:765-827-5796
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12014747A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice