Provider Demographics
NPI:1013679638
Name:POLINA F RHOUDENKO DDS
Entity Type:Organization
Organization Name:POLINA F RHOUDENKO DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:POLINA
Authorized Official - Middle Name:F
Authorized Official - Last Name:RHOUDENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-716-1783
Mailing Address - Street 1:12021 WILSHIRE BLVD STE 321
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1206
Mailing Address - Country:US
Mailing Address - Phone:714-716-1783
Mailing Address - Fax:
Practice Address - Street 1:100 LAGUNA RD STE 210
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3633
Practice Address - Country:US
Practice Address - Phone:714-716-1783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106839OtherDENTIST