Provider Demographics
NPI:1871725093
Name:JUDELSON, BRIAN Z (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:Z
Last Name:JUDELSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12587 HESPERIA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8308
Mailing Address - Country:US
Mailing Address - Phone:762-417-0840
Mailing Address - Fax:
Practice Address - Street 1:12587 HESPERIA RD
Practice Address - Street 2:SUITE B
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8308
Practice Address - Country:US
Practice Address - Phone:762-417-0840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA285761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice