Healthcare Provider Details

I. General information

NPI: 1649107798
Provider Name (Legal Business Name): RUWAYDA MALIM RDH/DT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 BLOOMINGTON AVE
MINNEAPOLIS MN
55407-3662
US

IV. Provider business mailing address

11816 WAYZATA BLVD APT 407
MINNETONKA MN
55305-2004
US

V. Phone/Fax

Practice location:
  • Phone: 612-886-3270
  • Fax:
Mailing address:
  • Phone: 612-328-4127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH12116
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code125J00000X
TaxonomyDental Therapist
License NumberDT209
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: