Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 1976 | RI |
NPI | 1013028372 |
---|---|
Provider Name | Dr. Kenneth J Rudman |
First Address | Warwick, RI 02886-4617 |
Second Address | Warwick, RI 02886-4617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 12/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AR1532262 | DEA - DRUG (01) | |
KR00153 | (05) | RI |