Provider Demographics
NPI:1376910562
Name:CHRISTOPHER M. DUDZIK, DMD, INC.
Entity Type:Organization
Organization Name:CHRISTOPHER M. DUDZIK, DMD, INC.
Other - Org Name:CARLSBAD VILLAGE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DUDZIK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:760-434-3103
Mailing Address - Street 1:2815 JEFFERSON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1717
Mailing Address - Country:US
Mailing Address - Phone:760-434-3103
Mailing Address - Fax:760-434-3108
Practice Address - Street 1:2815 JEFFERSON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1717
Practice Address - Country:US
Practice Address - Phone:760-434-3103
Practice Address - Fax:760-434-3108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA626061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457793226OtherPERSONAL NPI #