Healthcare Provider Details

I. General information

NPI: 1700040706
Provider Name (Legal Business Name): RULAND FAMILY DENTISTRY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 FOREST DR SUITE 6
ANNAPOLIS MD
21403-1019
US

IV. Provider business mailing address

1616 FOREST DR SUITE 6
ANNAPOLIS MD
21403-1019
US

V. Phone/Fax

Practice location:
  • Phone: 410-268-5800
  • Fax: 410-268-0513
Mailing address:
  • Phone: 410-268-5800
  • Fax: 410-268-0513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number3446
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN P RULAND
Title or Position: PRESIDENT
Credential: DDS
Phone: 410-268-5800