Provider Demographics
NPI:1568672749
Name:DR. ROBERT K. RUDOLPH, D.M.D., PC
Entity Type:Organization
Organization Name:DR. ROBERT K. RUDOLPH, D.M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:RUDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-870-0280
Mailing Address - Street 1:1754 OXMOOR RD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-4056
Mailing Address - Country:US
Mailing Address - Phone:205-870-0280
Mailing Address - Fax:205-870-0285
Practice Address - Street 1:1754 OXMOOR RD
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-4056
Practice Address - Country:US
Practice Address - Phone:205-870-0280
Practice Address - Fax:205-870-0285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL51251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty