Healthcare Provider Details

I. General information

NPI: 1841933389
Provider Name (Legal Business Name): MARTA RUDAT DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/13/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1076 E 1ST ST STE D
TUSTIN CA
92780-3852
US

IV. Provider business mailing address

1076 E 1ST ST STE D
TUSTIN CA
92780-3852
US

V. Phone/Fax

Practice location:
  • Phone: 714-665-4200
  • Fax:
Mailing address:
  • Phone: 714-665-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NICOLE RUDAT
Title or Position: OFFICE MANAGER
Credential:
Phone: 714-606-4725