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Judson Charles Smith

Dentist

Dental Providers

2323 N Mayfair Rd Ste 102, Milwaukee, WI 53226

PECOS Enrollment

This provider is enrolled in PECOS as JUDSON SMITH.

Based on the most recent information from CMS, provider Judson Charles Smith is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1952717753
Provider Type
Individual
Full Name
Smith, Judson Charles
Title
Dr.

Gender
Male
Sole Proprietor
No
Enumeration Date
7/1/2014
Last Updated
8/3/2018

Contact Information

Practice Location

2323 N Mayfair Rd Ste 102, Milwaukee, WI 53226

(414) 257-1161

(414) 257-0194

Mailing Location

2323 N Mayfair Rd Ste 102, Milwaukee, WI 53226-1506

(414) 257-1161

(414) 257-0194

Provider Taxonomies

Code	Description	License
Code 1223S0112X Primary	Description Dentist Dental Providers	License 1001751-015 Wisconsin

Judson Charles Smith

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Brookes, Carolyn C

Gingrass, David J

Smith, Kyle David

Brian J. Blocher Dds Sc

Delaura, Taylor Louise

Hawkins, Philip L

Milwaukee Oral Surgery & Implants Ltd

Waligora, Bret

Midtling, Matthew James

Miller, Anne W