Provider Demographics
NPI:1902098114
Name:RUDNICKI, ALYSE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ALYSE
Middle Name:
Last Name:RUDNICKI
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 OLD TAPPAN RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-7000
Mailing Address - Country:US
Mailing Address - Phone:201-666-8844
Mailing Address - Fax:201-666-8811
Practice Address - Street 1:215 OLD TAPPAN RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:OLD TAPPAN
Practice Address - State:NJ
Practice Address - Zip Code:07675-7000
Practice Address - Country:US
Practice Address - Phone:201-666-8844
Practice Address - Fax:201-666-8811
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-11
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022732001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics