Provider Demographics
NPI:1013028372
Name:RUDMAN, KENNETH J (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:RUDMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 VETERANS MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4617
Mailing Address - Country:US
Mailing Address - Phone:401-737-5449
Mailing Address - Fax:401-732-3695
Practice Address - Street 1:35 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4617
Practice Address - Country:US
Practice Address - Phone:401-737-5449
Practice Address - Fax:401-732-3695
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI1976122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIKR00153Medicaid
AR1532262OtherDEA - DRUG