Carl Ruderman DDS LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

CARL RUDERMAN DDS LLC

Practice address

6309 Baltimore Ave Ste 202
Riverdale, MD 20737-1059

Phone

(301) 864-6535

Fax

(301) 864-8093

NPI assigned

Feb 26, 2020

Organization subpart

No

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

Authorized official

Name

Casey Ruderman

Title

Office Manager

Phone

(301) 864-6535

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1582675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582675200000",
    "number": "1508490707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6309 BALTIMORE AVE STE 202",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207371059",
            "telephone_number": "301-864-6535",
            "fax_number": "301-864-8093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6309 BALTIMORE AVE STE 202",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207371059",
            "telephone_number": "301-864-6535",
            "fax_number": "301-864-8093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARL RUDERMAN DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-26",
        "last_updated": "2020-02-26",
        "certification_date": "2020-02-26",
        "status": "A",
        "authorized_official_last_name": "RUDERMAN",
        "authorized_official_first_name": "CASEY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "301-864-6535"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Riverdale, MD
• Oral and Maxillofacial Surgery (Dentist) in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2020; 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.