Provider Demographics
NPI:1336328509
Name:AMES ORAL SURGEONS, P.C.
Entity Type:Organization
Organization Name:AMES ORAL SURGEONS, P.C.
Other - Org Name:MARSHALLTOWN ORAL SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:515-232-6830
Mailing Address - Street 1:1212 DUFF AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-5467
Mailing Address - Country:US
Mailing Address - Phone:515-232-6830
Mailing Address - Fax:515-232-3296
Practice Address - Street 1:1212 DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5467
Practice Address - Country:US
Practice Address - Phone:515-232-6830
Practice Address - Fax:515-232-3296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA5764261QS0112X
IA7879261QS0112X
IA07882261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U81128Medicare UPIN
U37356Medicare UPIN
T00885Medicare UPIN