Provider Demographics
NPI:1790848927
Name:RUDE, JOEL MATTHEW (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:MATTHEW
Last Name:RUDE
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 1:22142 SE 237TH STREET
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-8534
Mailing Address - Country:US
Mailing Address - Phone:425-432-1292
Mailing Address - Fax:425-432-0192
Practice Address - Street 1:22142 SE 237TH STREET
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-8534
Practice Address - Country:US
Practice Address - Phone:425-432-1292
Practice Address - Fax:425-432-0192
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000082191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5042726OtherDSHS