Provider Demographics
NPI:1386681856
Name:DUDA, JOHN EDWAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWAR
Last Name:DUDA
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 1:21851 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3976
Mailing Address - Country:US
Mailing Address - Phone:440-333-9532
Mailing Address - Fax:440-333-9533
Practice Address - Street 1:21851 CENTER RIDGE RD
Practice Address - Street 2:SUITE 311
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3976
Practice Address - Country:US
Practice Address - Phone:440-333-9532
Practice Address - Fax:440-333-9533
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH154221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice