Provider Demographics
NPI:1356447684
Name:BERUDE, JOHN A (DDS, FICD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:BERUDE
Suffix:
Gender:M
Credentials:DDS, FICD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6715 FORT DENT WAY
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2540
Mailing Address - Country:US
Mailing Address - Phone:206-248-3330
Mailing Address - Fax:206-431-1158
Practice Address - Street 1:6715 FORT DENT WAY
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2540
Practice Address - Country:US
Practice Address - Phone:206-248-3330
Practice Address - Fax:206-431-1158
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA53881223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics