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General NPI Number Information
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NPI Number | 1215059597
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Entity Type | Organization
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Legal Business Name | PAUL E RUDNICKE DDS PA
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 09/03/2007
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Provider Practice Location Address
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Address Line | 1704 S HAWTHORNE RD
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City | WINSTON SALEM
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State | NC
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Zip | 27103-4016
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Country | US
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Telephone | 336-768-3040
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Fax |
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Provider Business Mailing Address
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Address Line | 1704 S HAWTHORNE RD
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City | WINSTON SALEM
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State | NC
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Zip | 27103-4016
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL E RUDNICKE
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Credential |
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Telephone | 336-768-3040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 7543
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License Number State | NC
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