Paul Stanley Kudyba Jr., DDS
Individual provider Active NPI Prosthodontics · Sugar Hill, GA
NPI 1760540652 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1760540652
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Prosthodontics 1223P0700X
- License
- 9565 (GA)
- Practice address
- 4740 Nelson Brogdon Blvd
Sugar Hill, GA 30518 - Phone
- (770) 945-5027
- Fax
- (770) 945-1362
- NPI assigned
- Dec 5, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9565 | GA | MD | Prosthodontist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 9565 | GA | Yes |
| Prosthodontics | 1223P0700X | 5025 | NC |
Addresses
Primary practice location
4740 Nelson Brogdon Blvd
Sugar Hill, GA 30518
Mailing address
4740 Nelson Brogdon Blvd
Sugar Hill, GA 30518
Phone (770) 945-5027
Other providers in Sugar Hill, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.