Provider Demographics
NPI:1023072576
Name:RUDOLF, DONALD (DMD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:RUDOLF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 PROGRESS DR
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-2511
Mailing Address - Country:US
Mailing Address - Phone:215-348-8040
Mailing Address - Fax:215-348-7456
Practice Address - Street 1:103 PROGRESS DR
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2511
Practice Address - Country:US
Practice Address - Phone:215-348-8040
Practice Address - Fax:215-348-7456
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS015499L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA061727XTCMedicare PIN