Individual
DR. LUCAS JOHN RUDELICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5255 S 4015 W, SUITE #180, TAYLORSVILLE, UT 84129-4257
(801) 968-9003
(801) 968-9069
Mailing address
5255 S 4015 W, SUITE #180, TAYLORSVILLE, UT 84129-4257
(801) 968-9003
(801) 968-9069
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
10165628-9922
UT
Other
Enumeration date
11/21/2016
Last updated
11/21/2016
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