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General NPI Number Information
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NPI Number | 1104995802
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Entity Type | Individual
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Provider Name | DEBORAH SUE RUDDELL DDS
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Gender | Female
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 49 BARKLEY CIR
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City | FORT MYERS
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State | FL
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Zip | 33907-7531
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Country | US
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Telephone | 239-936-8616
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Fax | 239-936-1146
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Provider Business Mailing Address
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Address Line | 49 BARKLEY CIR
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City | FORT MYERS
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State | FL
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Zip | 33907-7531
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Country | US
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Telephone | 239-936-8616
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Fax | 239-936-1146
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN 10865
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License Number State | FL
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