Healthcare Provider Details

I. General information

NPI: 1295748119
Provider Name (Legal Business Name): ALICE RUDIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICE ZISKIND DDS

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 OLD NORTH RD DEPARTMENT OF DENTISTRY
WORTHINGTON MA
01098-9753
US

IV. Provider business mailing address

21 LOIS ST
NORTH ADAMS MA
01247-3019
US

V. Phone/Fax

Practice location:
  • Phone: 413-238-5511
  • Fax:
Mailing address:
  • Phone: 413-664-4068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21407
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: