Healthcare Provider Details

I. General information

NPI: 1336328509
Provider Name (Legal Business Name): AMES ORAL SURGEONS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 DUFF AVE
AMES IA
50010-5467
US

IV. Provider business mailing address

1212 DUFF AVE
AMES IA
50010-5467
US

V. Phone/Fax

Practice location:
  • Phone: 515-232-6830
  • Fax: 515-232-3296
Mailing address:
  • Phone: 515-232-6830
  • Fax: 515-232-3296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number5764
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number07882
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number7879
License Number StateIA

VIII. Authorized Official

Name: DR. ROBERT A RUDMAN
Title or Position: OFFICER
Credential: D.D.S., M.S.
Phone: 515-232-6830