Provider Demographics
NPI:1508448861
Name:RHOUDENKO, POLINA FEDOROVNA (DMD)
Entity Type:Individual
Prefix:DR
First Name:POLINA
Middle Name:FEDOROVNA
Last Name:RHOUDENKO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12021 WILSHIRE BLVD UNIT 321
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1206
Mailing Address - Country:US
Mailing Address - Phone:714-746-1923
Mailing Address - Fax:
Practice Address - Street 1:100 LAGUNA RD STE 210
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3633
Practice Address - Country:US
Practice Address - Phone:714-716-1783
Practice Address - Fax:949-749-6620
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1068391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty