Provider Demographics
NPI:1306866801
Name:RUDO, JAY YALE (DDS)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:YALE
Last Name:RUDO
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 1:1401 PULASKI HWY STE V
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-1398
Mailing Address - Country:US
Mailing Address - Phone:410-679-2523
Mailing Address - Fax:
Practice Address - Street 1:1401 PULASKI HWY STE V
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-1398
Practice Address - Country:US
Practice Address - Phone:410-679-2523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD48431223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics