Provider Demographics
NPI:1932235678
Name:DR LEO A RUDOY DDS DENTAL CORPORATION
Entity type:Organization
Organization Name:DR LEO A RUDOY DDS DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:ARONI
Authorized Official - Last Name:RUDOY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-993-0202
Mailing Address - Street 1:21534 DEVONSHIRE ST
Mailing Address - Street 2:#'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:#'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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51132122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG89997-01Medicare ID - Type UnspecifiedBILLING PROVIDER
CA523739Medicare ID - Type UnspecifiedDENTICAL
CAD51132Medicare ID - Type UnspecifiedTREATING PROVIDER