# CARL RUDERMAN DDS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508490707
- **Authorized official:** CASEY RUDERMAN (OFFICE MANAGER)
- **Authorized official phone:** (301) 864-6535

## Contact information

- **Practice address:** 6309 BALTIMORE AVE STE 202, RIVERDALE, MD 20737-1059
- **Practice address phone:** (301) 864-6535
- **Practice address fax:** (301) 864-8093
- **Mailing address:** 6309 BALTIMORE AVE STE 202, RIVERDALE, MD 20737-1059
- **Mailing address phone:** (301) 864-6535
- **Mailing address fax:** (301) 864-8093

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 02/26/2020
- **Last updated:** 02/26/2020