Provider Demographics
NPI:1255052536
Name:RUDIAK, ADRIAN MICHAL (DDS)
Entity type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:MICHAL
Last Name:RUDIAK
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 1:3535 S BALL ST APT 705
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-4434
Mailing Address - Country:US
Mailing Address - Phone:845-537-8484
Mailing Address - Fax:
Practice Address - Street 1:7800 SUDLEY RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2804
Practice Address - Country:US
Practice Address - Phone:571-535-2365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014181461223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics