Provider Demographics
NPI:1922128321
Name:DUDZIAK, MATTHEW EDWARD (DDS MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:EDWARD
Last Name:DUDZIAK
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Gender:M
Credentials:DDS MD
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Mailing Address - Street 1:8112 MILLIKEN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7471
Mailing Address - Country:US
Mailing Address - Phone:909-581-7761
Mailing Address - Fax:909-581-7766
Practice Address - Street 1:8112 MILLIKEN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7471
Practice Address - Country:US
Practice Address - Phone:909-581-7761
Practice Address - Fax:909-581-7766
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2008-03-06
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Provider Licenses
StateLicense IDTaxonomies
LA54401223S0112X
PAMD428786204E00000X
CAA98904204E00000X
LAMD200551204E00000X
CA731223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery