Provider Demographics
NPI:1407066756
Name:RUDOLPH, ROBERT KYLE (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:KYLE
Last Name:RUDOLPH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1754 OXMOOR RD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-4056
Mailing Address - Country:US
Mailing Address - Phone:205-870-0280
Mailing Address - Fax:205-870-0285
Practice Address - Street 1:1754 OXMOOR RD
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-4056
Practice Address - Country:US
Practice Address - Phone:205-870-0280
Practice Address - Fax:205-870-0285
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5125122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist