Healthcare Provider Details

I. General information

NPI: 1174802904
Provider Name (Legal Business Name): NICHOLAS JAMES RUGGIERO D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 MEDICAL CIR
WEST COLUMBIA SC
29169-3655
US

IV. Provider business mailing address

125 MEDICAL CIR
WEST COLUMBIA SC
29169-3655
US

V. Phone/Fax

Practice location:
  • Phone: 803-673-4776
  • Fax:
Mailing address:
  • Phone: 803-673-4776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7070
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: