Healthcare Provider Details

I. General information

NPI: 1679671192
Provider Name (Legal Business Name): EDWARD LEIGH RUCH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 ORANGE PL SUITE 185
BEACHWOOD OH
44122-4464
US

IV. Provider business mailing address

3690 ORANGE PL SUITE 185
BEACHWOOD OH
44122-4464
US

V. Phone/Fax

Practice location:
  • Phone: 216-378-1919
  • Fax: 216-378-9737
Mailing address:
  • Phone: 216-378-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30.015246
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: