Provider Demographics
NPI:1861739112
Name:NUDELMAN, KWANGMEE
Entity type:Individual
Prefix:MRS
First Name:KWANGMEE
Middle Name:
Last Name:NUDELMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 303
Mailing Address - Street 2:BOX 29
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96204-9998
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SOUTH POST BLDG #7005
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96205-5556
Practice Address - Country:US
Practice Address - Phone:315-737-3155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10134124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist