Provider Demographics
NPI:1831738798
Name:UVADYEV, RUDOLF (DMD)
Entity type:Individual
Prefix:DR
First Name:RUDOLF
Middle Name:
Last Name:UVADYEV
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 1:318 W MURIEL DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-6524
Mailing Address - Country:US
Mailing Address - Phone:602-334-3727
Mailing Address - Fax:
Practice Address - Street 1:318 W MURIEL DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-6524
Practice Address - Country:US
Practice Address - Phone:602-334-3727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-24
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10542122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist