Glenn Rudolph, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

9731 Issued in KY

Practice address

3707 Chamberlain LN
Suite 103
Louisville, KY 40241-2001

Phone

(502) 412-2222

NPI assigned

Feb 19, 2012

Last updated

Jul 6, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Edp of Kentucky PC

  • Dental Clinic/Center
  • Henderson, KY
  • NPI 1508367665
  NPD (past)

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

{
    "created_epoch": "1329609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467763200000",
    "number": "1033482260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1802 STRAND AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402051432",
            "telephone_number": "256-762-8908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3707 CHAMBERLAIN LN",
            "address_2": "SUITE 103",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402412001",
            "telephone_number": "502-412-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "GLENN",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-02-19",
        "last_updated": "2016-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AL",
            "license": "6014",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "9731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rosella Castelli Rudd, LCSW
• Sarah M Rudd, LCSW
• Reneisha Rudder
• Jacqueline S Rudisell, COTA/L
• Carmon R Rudolph, DMD
• Nathaniel Rudolph
• Bhagyalaxmi Rudravaram, M.D.
• Alysia R. Rue
• Barbara Susan Ruedel, R.D.
• Lauren Ruedel, LMFT

• Dentist in Louisville, KY
• Providers in Louisville, KY by specialty
• Dentist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.