Provider Demographics
NPI:1700904885
Name:CUDIA, ROBERT (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:CUDIA
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 1:1417 SYLVAN CIR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3423
Mailing Address - Country:US
Mailing Address - Phone:404-262-9968
Mailing Address - Fax:
Practice Address - Street 1:2460 CUMBERLAND PKWY SE
Practice Address - Street 2:210
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-4519
Practice Address - Country:US
Practice Address - Phone:770-433-2414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0110831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice