Provider Demographics
NPI:1801017439
Name:KALUDY, MICHAEL ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:KALUDY
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 1:193 EAST AVE.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2341
Mailing Address - Country:US
Mailing Address - Phone:330-633-0324
Mailing Address - Fax:330-633-0546
Practice Address - Street 1:193 EAST AVE.
Practice Address - Street 2:SUITE 202
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2341
Practice Address - Country:US
Practice Address - Phone:330-633-0324
Practice Address - Fax:330-633-0546
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0136931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice