Provider Demographics
NPI:1558591354
Name:RUDIC, ANDREI (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREI
Middle Name:
Last Name:RUDIC
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 1:106 PARKHURST ST
Mailing Address - Street 2:
Mailing Address - City:ELKLAND
Mailing Address - State:PA
Mailing Address - Zip Code:16920-1110
Mailing Address - Country:US
Mailing Address - Phone:814-517-4123
Mailing Address - Fax:814-517-4189
Practice Address - Street 1:106 PARKHURST ST
Practice Address - Street 2:
Practice Address - City:ELKLAND
Practice Address - State:PA
Practice Address - Zip Code:16920-1110
Practice Address - Country:US
Practice Address - Phone:814-517-4123
Practice Address - Fax:814-517-4189
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0351031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice