Provider Demographics
NPI:1508517418
Name:NICHOLAS M RUDY DDS INC
Entity Type:Organization
Organization Name:NICHOLAS M RUDY DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:216-407-4805
Mailing Address - Street 1:5 SEVERANCE CIR STE 710
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1590
Mailing Address - Country:US
Mailing Address - Phone:216-381-0628
Mailing Address - Fax:216-381-3380
Practice Address - Street 1:5 SEVERANCE CIR STE 710
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1590
Practice Address - Country:US
Practice Address - Phone:216-381-0628
Practice Address - Fax:216-381-3380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty