Provider Demographics
NPI:1922019330
Name:RUDERMAN, CARL (DDS)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:RUDERMAN
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 1:6309 BALTIMORE AVENUE #202
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1022
Mailing Address - Country:US
Mailing Address - Phone:301-864-6535
Mailing Address - Fax:301-864-8093
Practice Address - Street 1:6309 BALTIMORE AVENUE #202
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1022
Practice Address - Country:US
Practice Address - Phone:301-864-6535
Practice Address - Fax:301-864-8093
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD68271223S0112X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery