Healthcare Provider Details

I. General information

NPI: 1730212135
Provider Name (Legal Business Name): JOHN MICHAEL RUGGIERI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 S BROAD ST
PHILADELPHIA PA
19148-2216
US

IV. Provider business mailing address

36 WORTHINGTON AVE
BELLMAWR NJ
08031-2144
US

V. Phone/Fax

Practice location:
  • Phone: 215-465-6060
  • Fax:
Mailing address:
  • Phone: 215-313-7866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS030472-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: