Provider Demographics
NPI:1528253903
Name:RUDOY, LEO ARONI (DDS)
Entity type:Individual
Prefix:DR
First Name:LEO
Middle Name:ARONI
Last Name:RUDOY
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 1:21534 DEVONSHIRE ST
Mailing Address - Street 2:SUITE #C
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-2987
Mailing Address - Country:US
Mailing Address - Phone:818-993-0202
Mailing Address - Fax:818-993-0102
Practice Address - Street 1:21534 DEVONSHIRE ST
Practice Address - Street 2:SUITE #C
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-2987
Practice Address - Country:US
Practice Address - Phone:818-993-0202
Practice Address - Fax:818-993-0102
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD51132122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG89997-01OtherMEDICARE BILLING PROVIDER
CAD51132OtherMEDICARE TREATING PROVIDE
CAG89997-01OtherMEDICARE BILLING PROVIDER