Healthcare Provider Details

I. General information

NPI: 1538215645
Provider Name (Legal Business Name): ROBERT J. KUDLA D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 SPRINGFIELD AVE
MOUNTAINSIDE NJ
07092-2906
US

IV. Provider business mailing address

1132 SPRINGFIELD AVE
MOUNTAINSIDE NJ
07092-2906
US

V. Phone/Fax

Practice location:
  • Phone: 908-232-6900
  • Fax: 908-232-8849
Mailing address:
  • Phone: 908-232-6900
  • Fax: 908-232-8849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDI 15169
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: