Provider Demographics
NPI:1851538698
Name:YEVGENY RUDASHEVSKY, D.D.S.,INC
Entity Type:Organization
Organization Name:YEVGENY RUDASHEVSKY, D.D.S.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YEVGENY
Authorized Official - Middle Name:G
Authorized Official - Last Name:RUDASHEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-774-1511
Mailing Address - Street 1:1567 SUNNYVALE SARATOGA RD
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-4571
Mailing Address - Country:US
Mailing Address - Phone:408-774-1511
Mailing Address - Fax:408-774-0189
Practice Address - Street 1:1567 SUNNYVALE SARATOGA RD
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-4571
Practice Address - Country:US
Practice Address - Phone:408-774-1511
Practice Address - Fax:408-774-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB40720261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental