Provider Demographics
NPI:1033234711
Name:DITTRICH, RUDOLPH EUGENE (DDS)
Entity Type:Individual
Prefix:MR
First Name:RUDOLPH
Middle Name:EUGENE
Last Name:DITTRICH
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 1:20445 PACIFICA DRIVE
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014
Mailing Address - Country:US
Mailing Address - Phone:408-255-9422
Mailing Address - Fax:408-295-4820
Practice Address - Street 1:20445 PACIFICA DRIVE
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3017
Practice Address - Country:US
Practice Address - Phone:408-255-9422
Practice Address - Fax:408-295-4820
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice