Matthew Seth Rudolph, D.M.D.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DS030358L Issued in PA

Practice address

2696 Olivia Heights Ave
Henderson, NV 89052-7039

Phone

(901) 289-2494

NPI assigned

Jun 28, 2006

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1487682720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2696 OLIVIA HEIGHTS AVE",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890527039",
            "telephone_number": "901-289-2494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2696 OLIVIA HEIGHTS AVE",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890527039",
            "telephone_number": "901-289-2494"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "903 Dublin Way",
            "address_purpose": "LOCATION",
            "city": "Chester Springs",
            "state": "PA",
            "postal_code": "194253833",
            "country_code": "US",
            "telephone_number": "901-289-2494",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "MATTHEW",
        "middle_name": "SETH",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "PA",
            "license": "DS030358L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Ruan
• Eunicelee Ruark
• Kimberly Rubin
• Leah Rubinstein, M.S. CCC-SLP
• Elizabeth Ruddick
• Nicole Ruffino
• Darian C Ruffins
• Marie Ruffo
• Gerilyn Rufin
• Johnathan Cesare Ruggeroli

• Periodontics in Henderson, NV
• Providers in Henderson, NV by specialty
• Periodontics in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; 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.