Provider Demographics
NPI:1467709899
Name:RUDAT, MARTA V (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTA
Middle Name:V
Last Name:RUDAT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARTA
Other - Middle Name:V
Other - Last Name:RUDAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1076 E 1ST ST STE D
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3852
Mailing Address - Country:US
Mailing Address - Phone:714-398-0114
Mailing Address - Fax:
Practice Address - Street 1:1076 E 1ST ST STE D
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3852
Practice Address - Country:US
Practice Address - Phone:714-398-0114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61501122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist