Provider Demographics
NPI:1487682720
Name:RUDOLPH, MATTHEW SETH (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SETH
Last Name:RUDOLPH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2696 OLIVIA HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-7039
Mailing Address - Country:US
Mailing Address - Phone:901-289-2494
Mailing Address - Fax:
Practice Address - Street 1:2696 OLIVIA HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-7039
Practice Address - Country:US
Practice Address - Phone:901-289-2494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030358L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics