Provider Demographics
NPI:1437647419
Name:ROJAS-RUDOLPH, ISOLDE GINA (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:ISOLDE
Middle Name:GINA
Last Name:ROJAS-RUDOLPH
Suffix:
Gender:F
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:ISOLDE
Other - Middle Name:GINA
Other - Last Name:ROJAS RUDOLPH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, PHD
Mailing Address - Street 1:250 SQUIRE HALL
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-8006
Mailing Address - Country:US
Mailing Address - Phone:716-829-3845
Mailing Address - Fax:716-829-6840
Practice Address - Street 1:325 SQUIRE HALL
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-8006
Practice Address - Country:US
Practice Address - Phone:716-829-2836
Practice Address - Fax:716-833-3517
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000081-01122300000X
NY000081-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000081-1OtherLICENSE FOR DENTIST AS DENTAL FACULTY
NY774OtherPROVIDER NUMBER AT THE UNIVERSITY AT BUFFALO SCHOOL OF DENTAL MEDICINE