Healthcare Provider Details

I. General information

NPI: 1053312769
Provider Name (Legal Business Name): FRANK P RUDEY DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 TALBOT RD S
RENTON WA
98055-5700
US

IV. Provider business mailing address

4033 TALBOT RD S SUITE #240
RENTON WA
98055-5772
US

V. Phone/Fax

Practice location:
  • Phone: 425-430-1320
  • Fax:
Mailing address:
  • Phone: 425-430-1320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9474
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: