Provider Demographics
NPI:1336752120
Name:DAZZLING DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:DAZZLING DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:W
Authorized Official - Last Name:RUDNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-923-0905
Mailing Address - Street 1:22029 STATE ROAD 7 STE 1
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4200
Mailing Address - Country:US
Mailing Address - Phone:561-923-0905
Mailing Address - Fax:
Practice Address - Street 1:22029 STATE ROAD 7 STE 1
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-4200
Practice Address - Country:US
Practice Address - Phone:561-923-0905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty