Basic Information
| Provider Information | |||||||||
| NPI: | 1609154855 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EUGENE | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | THEOMAT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2250 CHAMPLAIN STREET SW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200092618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2022329022 | ||||||||
| FaxNumber: | 2022328494 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 GALEN ST SE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200204936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2026107160 | ||||||||
| FaxNumber: | 2026107164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2011 | ||||||||
| LastUpdateDate: | 11/30/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DEN1001135 | DC | Y | Dental Providers | Dentist | General Practice |
No ID Information.