=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770617573
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARTIN M DUDAS DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 SHAW DR
-----------------------------------------------------
City | MONESSEN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15062-2318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-298-8304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 538 VINE ST
-----------------------------------------------------
City | JOHNSTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15901-2013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-535-8321
-----------------------------------------------------
Fax | 724-684-5734
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OWNER
-----------------------------------------------------
Name | DR. MARTIN M DUDAS
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 814-535-8321
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | DS015875L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------