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General NPI Number Information
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NPI Number | 1831873256
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Entity Type | Individual
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Provider Name | ROBERT BLAKEMORE RUEFF DMD
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Gender | Male
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Dates
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Enumeration Date | 06/14/2023
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 9231 OLD LORRAINE RD
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City | GULFPORT
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State | MS
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Zip | 39503-6060
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Country | US
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Telephone | 228-604-2445
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Fax |
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Provider Business Mailing Address
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Address Line | 528 NEWBURY DR
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City | MADISON
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State | MS
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Zip | 39110-4574
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Country | US
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Telephone | 601-667-7980
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4391-23
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License Number State | MS
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