Provider Demographics
NPI:1295748119
Name:RUDIN, ALICE (DDS)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:
Last Name:RUDIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ALICE
Other - Middle Name:
Other - Last Name:ZISKIND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:21 LOIS ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-3019
Mailing Address - Country:US
Mailing Address - Phone:413-664-4068
Mailing Address - Fax:
Practice Address - Street 1:58 OLD NORTH RD
Practice Address - Street 2:DEPARTMENT OF DENTISTRY
Practice Address - City:WORTHINGTON
Practice Address - State:MA
Practice Address - Zip Code:01098-9753
Practice Address - Country:US
Practice Address - Phone:413-238-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice