Provider Demographics
NPI:1013991421
Name:NUDEL, TATYANA (DMD)
Entity Type:Individual
Prefix:DR
First Name:TATYANA
Middle Name:
Last Name:NUDEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7321 NORTH STATE ROAD 7
Mailing Address - Street 2:DEDICATED DENTAL GROUP
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33073
Mailing Address - Country:US
Mailing Address - Phone:954-796-9900
Mailing Address - Fax:954-796-9988
Practice Address - Street 1:7321 N STATE ROAD 7
Practice Address - Street 2:DEDICATED DENTAL GROUP
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33073-4527
Practice Address - Country:US
Practice Address - Phone:954-796-9900
Practice Address - Fax:954-796-9988
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN159041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN15904OtherDENTAL LICENSE ID