Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 7543 | NC |
NPI | 1043332323 |
---|---|
Provider Name | Paul E Rudnicke |
First Address | Winston Salem, NC 27103-4016 |
Second Address | Winston Salem, NC 27103-4016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 08/07/2007 |