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General NPI Number Information
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NPI Number | 1932235678
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Entity Type | Organization
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Legal Business Name | DR LEO A RUDOY DDS DENTAL CORPORATION
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 01/16/2014
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Provider Practice Location Address
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Address Line | 21534 DEVONSHIRE ST #'C'
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City | CHATSWORTH
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State | CA
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Zip | 91311-2987
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Country | US
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Telephone | 818-993-0202
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Fax | 818-993-0102
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Provider Business Mailing Address
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Address Line | 21534 DEVONSHIRE ST #'C'
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City | CHATSWORTH
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State | CA
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Zip | 91311-2987
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Country | US
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Telephone | 818-993-0202
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Fax | 818-993-0102
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Authorized Official
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Title or Position | DENTIST
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Name | LEO ARONI RUDOY
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Credential | D.D.S.
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Telephone | 818-993-0202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 51132
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License Number State | CA
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