Individual
GLENN RUDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
3707 CHAMBERLAIN LN, SUITE 103, LOUISVILLE, KY 40241-2001
(502) 412-2222
Mailing address
1802 STRAND AVE, LOUISVILLE, KY 40205-1432
(256) 762-8908
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
6014
AL
122300000X
Dentist
Primary
9731
KY
Other
Enumeration date
02/19/2012
Last updated
07/06/2016
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