Provider Demographics
NPI:1649312158
Name:KUDRYK, VAL L (DMD)
Entity type:Individual
Prefix:DR
First Name:VAL
Middle Name:L
Last Name:KUDRYK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 MISTY MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-5819
Mailing Address - Country:US
Mailing Address - Phone:928-443-9151
Mailing Address - Fax:
Practice Address - Street 1:3103 CLEARWATER DR
Practice Address - Street 2:SUITE A
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7165
Practice Address - Country:US
Practice Address - Phone:928-443-0955
Practice Address - Fax:928-443-0931
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD67921223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics