Provider Demographics
NPI:1689646945
Name:RUDE, CAROLYN S (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:S
Last Name:RUDE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 RIVER NORTH PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-1117
Mailing Address - Country:US
Mailing Address - Phone:770-396-7960
Mailing Address - Fax:
Practice Address - Street 1:205 HAWKINS STORE ROAD
Practice Address - Street 2:SUITE A-1
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144
Practice Address - Country:US
Practice Address - Phone:770-926-3400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA83811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000236926A1Medicaid