Provider Demographics
NPI:1891329140
Name:MAYER, RUDOLF ERNST (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUDOLF
Middle Name:ERNST
Last Name:MAYER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:R
Other - Middle Name:E
Other - Last Name:MAYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:15141 WHITTIER BLVD STE 255
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2177
Mailing Address - Country:US
Mailing Address - Phone:562-693-4171
Mailing Address - Fax:562-698-7827
Practice Address - Street 1:15141 WHITTIER BLVD STE 255
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2177
Practice Address - Country:US
Practice Address - Phone:562-693-4171
Practice Address - Fax:562-698-7827
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA313241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics