Provider Demographics
NPI:1841246832
Name:RUDERSDORF, THOMAS O'LEARY (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:O'LEARY
Last Name:RUDERSDORF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 N 57TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-2034
Mailing Address - Country:US
Mailing Address - Phone:402-556-9183
Mailing Address - Fax:402-556-6754
Practice Address - Street 1:11513 S 37TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-5210
Practice Address - Country:US
Practice Address - Phone:402-292-1200
Practice Address - Fax:402-292-5657
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist