Keith L. Rudolph, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

006950 Issued in CT

Practice address

140 Sherman St
Fairfield, CT 06824-5849

Phone

(203) 254-9533

NPI assigned

Apr 29, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

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

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

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209427200000",
    "number": "1124293196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 SHERMAN ST",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068245849",
            "telephone_number": "203-254-9533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 SHERMAN ST",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068245849",
            "telephone_number": "203-254-9533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "KEITH",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-29",
        "last_updated": "2008-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CT",
            "license": "006950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ching-Ching Ruan, LMFT
• Lucia Joy Rubin-Cadrain, SLP
• Carrie J Rubin, PH.D, LCSW
• Rubys Happiness LLC
• Andrea Schreibman Rudolph, LCSW, MSW, MPH
• Mary Rush, APRN
• Adam Russak, MD
• Sally W Russell, RDH
• Jane A. Russo, D.M.D.
• Luann Russo, CNM

• Dentist in Fairfield, CT
• Providers in Fairfield, CT by specialty
• Dentist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; 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.