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General NPI Number Information
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NPI Number | 1982990313
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Entity Type | Organization
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Legal Business Name | JULIAN M. TUDOSE, DDS, INC
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Dates
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Enumeration Date | 06/23/2011
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Last Update Date | 06/23/2011
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Provider Practice Location Address
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Address Line | 32999 YUCAIPA BLVD STE# 114
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City | YUCAIPA
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State | CA
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Zip | 92399-1963
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Country | US
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Telephone | 909-790-2941
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Fax | 909-790-2942
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Provider Business Mailing Address
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Address Line | 32999 YUCAIPA BLVD STE# 114
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City | YUCAIPA
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State | CA
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Zip | 92399-1963
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Country | US
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Telephone | 909-790-2941
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Fax | 909-790-2942
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Authorized Official
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Title or Position | OWNER
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Name | JULIAN M TUDOSE
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Credential |
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Telephone | 909-790-2941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 49821
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License Number State | CA
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