Provider Demographics
NPI:1033381934
Name:KUDLIK, DENNIS DONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:DONALD
Last Name:KUDLIK
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 1:2000 E CHAPMAN AVE
Mailing Address - Street 2:SUITE # 100
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4103
Mailing Address - Country:US
Mailing Address - Phone:714-526-2860
Mailing Address - Fax:
Practice Address - Street 1:2000 E CHAPMAN AVE
Practice Address - Street 2:SUITE # 100
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-4103
Practice Address - Country:US
Practice Address - Phone:714-526-2860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43708122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist