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General NPI Number Information
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NPI Number | 1295748119
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Entity Type | Individual
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Provider Name | ALICE RUDIN DDS
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Gender | Female
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 10/03/2011
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Provider Practice Location Address
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Address Line | 58 OLD NORTH RD DEPARTMENT OF DENTISTRY
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City | WORTHINGTON
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State | MA
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Zip | 01098-9753
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Country | US
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Telephone | 413-238-5511
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Fax |
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Provider Business Mailing Address
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Address Line | 21 LOIS ST
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City | NORTH ADAMS
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State | MA
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Zip | 01247-3019
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Country | US
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Telephone | 413-664-4068
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 21407
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License Number State | MA
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