Provider Demographics
NPI:1053474288
Name:JOEL M RUDE DMD PS
Entity Type:Organization
Organization Name:JOEL M RUDE DMD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:RUDE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:425-432-1292
Mailing Address - Street 1:22142 SE 237TH STREET
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-8534
Mailing Address - Country:US
Mailing Address - Phone:425-432-1292
Mailing Address - Fax:425-432-0192
Practice Address - Street 1:22142 SE 237TH STREET
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-8534
Practice Address - Country:US
Practice Address - Phone:425-432-1292
Practice Address - Fax:425-432-0192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5384102OtherDSHS OFFICE #