Provider Demographics
NPI:1407164692
Name:RUDELL, ROBERT HAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HAY
Last Name:RUDELL
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 1:840 OCEAN DR SW
Mailing Address - Street 2:
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411-9505
Mailing Address - Country:US
Mailing Address - Phone:541-347-2478
Mailing Address - Fax:
Practice Address - Street 1:840 OCEAN DR SW
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-9505
Practice Address - Country:US
Practice Address - Phone:541-347-2478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5991122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist