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General NPI Number Information
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NPI Number | 1649312158
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Entity Type | Individual
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Provider Name | VAL L KUDRYK D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3103 CLEARWATER DR SUITE A
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City | PRESCOTT
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State | AZ
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Zip | 86305-7165
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Country | US
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Telephone | 928-443-0955
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Fax | 928-443-0931
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Provider Business Mailing Address
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Address Line | 190 MISTY MEADOW CIR
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City | PRESCOTT
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State | AZ
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Zip | 86303-5819
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Country | US
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Telephone | 928-443-9151
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | D6792
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License Number State | AZ
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