Provider Demographics
NPI:1982794418
Name:RUDOLPH, DAVID JEFFREY (DDS MS PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JEFFREY
Last Name:RUDOLPH
Suffix:
Gender:M
Credentials:DDS MS PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9453 GIERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-4705
Mailing Address - Country:US
Mailing Address - Phone:818-718-1737
Mailing Address - Fax:818-718-1735
Practice Address - Street 1:9453 GIERSON AVE
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-4705
Practice Address - Country:US
Practice Address - Phone:818-718-1737
Practice Address - Fax:818-718-1735
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA362771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics