Provider Demographics
NPI:1568448322
Name:RUDLAFF, RONALD JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JOHN
Last Name:RUDLAFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66480 MULBERRY RD
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46536-9755
Mailing Address - Country:US
Mailing Address - Phone:574-784-2259
Mailing Address - Fax:
Practice Address - Street 1:3001A 6TH ST
Practice Address - Street 2:NAVAL HOSPITAL GREAT LAKES
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-5211
Practice Address - Country:US
Practice Address - Phone:847-688-2100
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009425A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist