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General NPI Number Information
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NPI Number | 1922128321
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Entity Type | Individual
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Provider Name | MATTHEW EDWARD DUDZIAK DDS MD
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Gender | Male
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 03/06/2008
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Provider Practice Location Address
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Address Line | 8112 MILLIKEN AVE SUITE 102
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-7471
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Country | US
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Telephone | 909-581-7761
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Fax | 909-581-7766
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Provider Business Mailing Address
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Address Line | 8112 MILLIKEN AVE SUITE 102
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-7471
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Country | US
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Telephone | 909-581-7761
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Fax | 909-581-7766
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 5440
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | MD428786
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | A98904
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | MD200551
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License Number State | LA
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Taxonomy #5
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 73
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License Number State | CA
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