Michael Lawrence Rudolph, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

12010923A Issued in IN

Practice address

2104 E Center St
Warsaw, IN 46580-3704

Phone

(574) 269-1787

Fax

(574) 267-1610

NPI assigned

Apr 17, 2007

Last updated

Dec 2, 2008By the provider in NPPES

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

Enrolled in IN

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.

• East Center Dental

  • General Practice Dentistry
  • Warsaw, IN
  • NPI 1366555823
  NPD (past)
• East Warsaw Dental Group LLC

  dba East Center Dental

  • General Practice Dentistry
  • Warsaw, IN
  • NPI 1366636870
  NPD (past)

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228176000000",
    "number": "1730305905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104 E CENTER ST",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465803704",
            "telephone_number": "574-269-1787",
            "fax_number": "574-267-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2104 E CENTER ST",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465803704",
            "telephone_number": "574-269-1787",
            "fax_number": "574-267-1610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "MICHAEL",
        "middle_name": "LAWRENCE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-17",
        "last_updated": "2008-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12010923A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katlyn M Romine, FNP-C
• Rheana Roose
• Cindy Lou Rosenbarger, OT
• Rebekah Jade Rowe, M.A.
• Marilyn Ann Roysdon, CADAC II
• Richard E Ruhrold, PH.D., HSPP
• Stephanie Ruiz
• Scott Nicholas Ruse, DPT
• Robert D Ryan, LMHC
• Caitlin J Ryser, MD

• Dentist in Warsaw, IN
• Providers in Warsaw, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 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.