=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760284293
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADAM S RUDIN DDS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2025
-----------------------------------------------------
Last Update Date | 03/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 520 LIMEKILN PIKE STE 13
-----------------------------------------------------
City | AMBLER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19002-2901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-603-6463
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1401 E OXFORD ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19125-4421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-420-1744
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ADAM RUDIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 908-420-1744
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------