Provider Demographics
NPI:1790994606
Name:DRAGULESCU, TUDOR AUREL (DMD)
Entity Type:Individual
Prefix:
First Name:TUDOR
Middle Name:AUREL
Last Name:DRAGULESCU
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 1:201 W 8TH ST
Mailing Address - Street 2:SUITE 810
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3038
Mailing Address - Country:US
Mailing Address - Phone:719-562-4447
Mailing Address - Fax:719-583-1801
Practice Address - Street 1:1800 E VICTORY DR STE 2
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-4195
Practice Address - Country:US
Practice Address - Phone:912-443-6013
Practice Address - Fax:912-443-6014
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3409122300000X
GADN0142971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZG4297Medicaid
GA003119458AMedicaid