Healthcare Provider Details

I. General information

NPI: 1366595308
Provider Name (Legal Business Name): JEFFREY RUGGIERO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 BROWERTOWN RD SUITE 004
WOODLAND PARK NJ
07424-2671
US

IV. Provider business mailing address

205 BROWERTOWN RD SUITE 004
WOODLAND PARK NJ
07424-2671
US

V. Phone/Fax

Practice location:
  • Phone: 973-256-0275
  • Fax: 973-256-8003
Mailing address:
  • Phone: 973-256-0275
  • Fax: 973-256-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDI019569
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: