Provider Demographics
NPI:1588905152
Name:YUDIN, ROBERT F (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F
Last Name:YUDIN
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 1:8 CEDAR ROAD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO OF SAN FELIPE
Mailing Address - State:NM
Mailing Address - Zip Code:87001-0000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 CEDAR ROAD
Practice Address - Street 2:
Practice Address - City:PUEBLO OF SAN FELIPE
Practice Address - State:NM
Practice Address - Zip Code:87001-0000
Practice Address - Country:US
Practice Address - Phone:505-771-9981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD28501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice