Provider Demographics
NPI:1801765813
Name:RUDY CARBALLO DDS PA
Entity type:Organization
Organization Name:RUDY CARBALLO DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARBALLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:941-257-8555
Mailing Address - Street 1:4901 WHITE IBIS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2641
Mailing Address - Country:US
Mailing Address - Phone:941-257-8555
Mailing Address - Fax:
Practice Address - Street 1:4901 WHITE IBIS DR
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2641
Practice Address - Country:US
Practice Address - Phone:941-257-8555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty