Dr Polina Rhoudenko DMD Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DR POLINA RHOUDENKO DMD INC

Practice address

100 Laguna Rd Ste 210
Fullerton, CA 92835-3633

Phone

(714) 716-1783

NPI assigned

Oct 11, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Polina Rhoudenko, DMD

Title

Dentist/President

Phone

(714) 716-1783

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746403200000",
    "number": "1013679638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12021 WILSHIRE BLVD STE 321",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900251206",
            "telephone_number": "714-716-1783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 LAGUNA RD STE 210",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353633",
            "telephone_number": "714-716-1783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR POLINA RHOUDENKO DMD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-11",
        "last_updated": "2025-05-05",
        "certification_date": "2025-05-05",
        "status": "A",
        "authorized_official_last_name": "RHOUDENKO",
        "authorized_official_first_name": "POLINA",
        "authorized_official_title_or_position": "DENTIST/PRESIDENT",
        "authorized_official_telephone_number": "714-716-1783",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTIST",
            "identifier": "106839",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508448861",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.