Dr Keith L Rudolph, DDS in Fairfield, CT - Medicare Dentist Provider

Dr Keith L Rudolph, DDS is a medicare enrolled "Dentist" provider in Fairfield, Connecticut. His current practice location is 140 Sherman St, Fairfield, Connecticut. You can reach out to his office (for appointments etc.) via phone at (203) 254-9533.

Dr Keith L Rudolph is licensed to practice in Connecticut (license number 006950) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1124293196.

Contact Information

	Dr Keith L Rudolph, DDS
	140 Sherman St, Fairfield, CT 06824-5849
	(203) 254-9533
	Not Available

Healthcare Provider's Profile

Full Name	Dr Keith L Rudolph
Gender	Male
Speciality	Dentist
Location	140 Sherman St, Fairfield, Connecticut
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1124293196
Provider Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008

Medicare PECOS Information:

PECOS PAC ID: 8820397805
Enrollment ID: I20160426000122

Medical Identifiers

Medical identifiers for Dr Keith L Rudolph such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1124293196	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
122300000X	Dentist	006950 (Connecticut)	Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Keith L Rudolph is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Dr Keith L Rudolph, DDS 140 Sherman St, Fairfield, CT 06824-5849 Ph: (203) 254-9533	Dr Keith L Rudolph, DDS 140 Sherman St, Fairfield, CT 06824-5849 Ph: (203) 254-9533

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Dentist in Fairfield, CT

Dr. Lawrence Henry Sprouse Jr., D.M.D. Dentist Medicare: Not Enrolled in Medicare Practice Location: 2452 Black Rock Tpke, Suite 12, Fairfield, CT 06825 Phone: 203-374-3886
Wendy Wang Austin, DMD Dentist Medicare: Medicare Enrolled Practice Location: 2226 Black Rock Tpke Ste 1, Fairfield, CT 06825 Phone: 203-366-7600
Leena Aslam, Dentist Medicare: Not Enrolled in Medicare Practice Location: 1305 Post Rd Ste 104, Fairfield, CT 06824 Phone: 203-256-8073
Dr. Kyeong-bin Im, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 400 Stillson Rd, Fairfield, CT 06824 Phone: 203-333-6171 Fax: 203-333-8641
Dr. Jeffrey S. Warren, D.M.D. Dentist Medicare: Not Enrolled in Medicare Practice Location: 1735 Post Rd, Suite 8, Fairfield, CT 06824 Phone: 203-259-1460 Fax: 203-259-4860
Dr. Gloria Maczuga-stern, DMD Dentist Medicare: Accepting Medicare Assignments Practice Location: 1100 Kings Hwy E, Suite 2e, Fairfield, CT 06825 Phone: 203-335-0020 Fax: 203-335-0030
David Nill, Dentist Medicare: Not Enrolled in Medicare Practice Location: 320 Post Road, Fairfield, CT 06824 Phone: 203-254-3780

Dr Keith L Rudolph, DDS - Medicare Dentist in Fairfield, CT