Provider Demographics
NPI:1407074081
Name:RUDISILL, WILLIAM BLAINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BLAINE
Last Name:RUDISILL
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 1:5803 W WILKINSON BLVD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-4809
Mailing Address - Country:US
Mailing Address - Phone:704-825-9991
Mailing Address - Fax:
Practice Address - Street 1:5803 W WILKINSON BLVD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-4809
Practice Address - Country:US
Practice Address - Phone:704-825-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC70271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice