Provider Demographics
NPI:1376186908
Name:UDAS, BEN
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:UDAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17575 YUKON AVE APT F3
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-3441
Mailing Address - Country:US
Mailing Address - Phone:857-206-3875
Mailing Address - Fax:
Practice Address - Street 1:2102 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-3003
Practice Address - Country:US
Practice Address - Phone:424-271-4714
Practice Address - Fax:424-488-7724
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-27
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1045001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice