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General NPI Number Information
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NPI Number | 1124363379
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Entity Type | Individual
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Provider Name | DANIEL BRUCE RUDD D.D.S, M.S.D
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Gender | Male
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Dates
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Enumeration Date | 11/28/2012
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 4320 RIDGECREST DR SE STE E
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City | RIO RANCHO
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State | NM
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Zip | 87124-5971
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Country | US
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Telephone | 505-891-1151
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Fax |
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Provider Business Mailing Address
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Address Line | 4320 RIDGECREST DR SE STE E
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City | RIO RANCHO
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State | NM
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Zip | 87124-5971
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Country | US
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Telephone |
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Fax |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DD3786
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License Number State | NM
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