Provider Demographics
NPI:1255579264
Name:RUDD, TRAVIS C (DDS)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:C
Last Name:RUDD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:10151 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3670
Mailing Address - Country:US
Mailing Address - Phone:505-292-3400
Mailing Address - Fax:505-292-7124
Practice Address - Street 1:10151 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE 2D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3670
Practice Address - Country:US
Practice Address - Phone:505-292-3400
Practice Address - Fax:505-292-7124
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMDD38811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery