Provider Demographics
NPI:1467654996
Name:TWIGGS, RUDOLPH LEVI (DMD)
Entity Type:Individual
Prefix:MR
First Name:RUDOLPH
Middle Name:LEVI
Last Name:TWIGGS
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 1:1804 W WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-1004
Mailing Address - Country:US
Mailing Address - Phone:813-933-6825
Mailing Address - Fax:813-930-7346
Practice Address - Street 1:1804 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-1004
Practice Address - Country:US
Practice Address - Phone:813-933-6825
Practice Address - Fax:813-930-7346
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL 82911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice