Provider Demographics
NPI:1457403917
Name:RUDOLPH, SARA BETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:BETH
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3539 S STERLING CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-4942
Mailing Address - Country:US
Mailing Address - Phone:773-430-7272
Mailing Address - Fax:
Practice Address - Street 1:21321 E OCOTILLO RD
Practice Address - Street 2:BUILDING E SUITE 112
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-5996
Practice Address - Country:US
Practice Address - Phone:480-882-9710
Practice Address - Fax:480-882-9706
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026167122300000X
AZD009520122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist