MEDICARE: DR. ALEXANDER RUDNITSKI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D10479	OR

General Provider Information

NPI Number	:	1598202996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER RUDNITSKI DMD

Provider Business Mailing Address
First Line	:	6319 SE POWELL BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-2751
Country	:	US
Telephone Number	:	503-772-3677
Fax Number	:

Provider Business Practice Location Address
First Line	:	6319 SE POWELL BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-2751
Country	:	US
Telephone Number	:	503-772-3677
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2017
Last Update Date	:	01/23/2017

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