Healthcare Provider Details

I. General information

NPI: 1851538698
Provider Name (Legal Business Name): YEVGENY RUDASHEVSKY, D.D.S.,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1567 SUNNYVALE SARATOGA RD
SUNNYVALE CA
94087-4571
US

IV. Provider business mailing address

1567 SUNNYVALE SARATOGA RD
SUNNYVALE CA
94087-4571
US

V. Phone/Fax

Practice location:
  • Phone: 408-774-1511
  • Fax: 408-774-0189
Mailing address:
  • Phone: 408-774-1511
  • Fax: 408-774-0189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberB40720
License Number StateCA

VIII. Authorized Official

Name: DR. YEVGENY G RUDASHEVSKY
Title or Position: DENTIST
Credential: DDS
Phone: 408-774-1511