Healthcare Provider Details

I. General information

NPI: 1396917290
Provider Name (Legal Business Name): KUDLIK DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E CHAPMAN AVE STE 100
FULLERTON CA
92831-4103
US

IV. Provider business mailing address

2000 E CHAPMAN AVE STE 100
FULLERTON CA
92831-4103
US

V. Phone/Fax

Practice location:
  • Phone: 714-526-2860
  • Fax: 714-526-6775
Mailing address:
  • Phone: 714-526-2860
  • Fax: 714-526-6775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number43708
License Number StateCA

VIII. Authorized Official

Name: DR. DENNIS DONALD KUDLIK
Title or Position: DENTIST
Credential: DDS
Phone: 714-526-2860