Healthcare Provider Details

I. General information

NPI: 1093625428
Provider Name (Legal Business Name): DAVID J RUDOLPH DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8619 RESEDA BLVD STE 108
NORTHRIDGE CA
91324-4060
US

IV. Provider business mailing address

8619 RESEDA BLVD STE 108
NORTHRIDGE CA
91324-4060
US

V. Phone/Fax

Practice location:
  • Phone: 818-718-1737
  • Fax: 818-337-2430
Mailing address:
  • Phone: 818-718-1737
  • Fax: 818-337-2430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DAVID RUDOLPH
Title or Position: OWNER
Credential: DDS MS PHD
Phone: 913-745-7373