Healthcare Provider Details

I. General information

NPI: 1356450464
Provider Name (Legal Business Name): CARL WILLIAM RUGGIERO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE MS 773
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE MS 773
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-2040
  • Fax: 414-266-5677
Mailing address:
  • Phone: 414-266-2040
  • Fax: 414-266-5677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number17902-875
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: