Healthcare Provider Details

I. General information

NPI: 1013326859
Provider Name (Legal Business Name): NICHOLAS RUANA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 09/09/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EVANS ARMY COMMUNITY HOSPITAL BLDG 7505
FORT CARSON CO
80913
US

IV. Provider business mailing address

USA MEDDAC EVANS ACH 1650 COCHRANE CIR. BLDG 7505
FORT CARSON CO
80913-4604
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7000
  • Fax:
Mailing address:
  • Phone: 719-526-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6534
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6534
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: