Healthcare Provider Details

I. General information

NPI: 1700904885
Provider Name (Legal Business Name): ROBERT CUDIA D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 CUMBERLAND PKWY SE 210
ATLANTA GA
30339-4519
US

IV. Provider business mailing address

1417 SYLVAN CIR NE
ATLANTA GA
30319-3423
US

V. Phone/Fax

Practice location:
  • Phone: 770-433-2414
  • Fax:
Mailing address:
  • Phone: 404-262-9968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN011083
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: