Provider Demographics
NPI:1649581703
Name:KURUDIMOV, ANDREY (DMD)
Entity type:Individual
Prefix:MR
First Name:ANDREY
Middle Name:
Last Name:KURUDIMOV
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 1:721 BUSTLETON PIKE
Mailing Address - Street 2:UNIT A
Mailing Address - City:FEASTERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19053
Mailing Address - Country:US
Mailing Address - Phone:215-703-9090
Mailing Address - Fax:
Practice Address - Street 1:721 BUSTLETON PIKE
Practice Address - Street 2:UNIT A
Practice Address - City:FEASTERVILLE
Practice Address - State:PA
Practice Address - Zip Code:19053
Practice Address - Country:US
Practice Address - Phone:215-703-9090
Practice Address - Fax:267-684-6957
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 0383231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice