Provider Demographics
NPI:1336779412
Name:RUDY, MELINDA ANN (RDH)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:ANN
Last Name:RUDY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 LOUDOUN RD
Mailing Address - Street 2:
Mailing Address - City:FARRAGUT
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2942
Mailing Address - Country:US
Mailing Address - Phone:865-966-7441
Mailing Address - Fax:865-966-4011
Practice Address - Street 1:111 LOUDOUN RD
Practice Address - Street 2:
Practice Address - City:FARRAGUT
Practice Address - State:TN
Practice Address - Zip Code:37934-2942
Practice Address - Country:US
Practice Address - Phone:865-966-7441
Practice Address - Fax:865-966-4011
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDH0000005293124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist