MEDICARE: DR. JOHN MICHAEL RUGGIERI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS030472-L	PA

General Provider Information

NPI Number	:	1730212135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MICHAEL RUGGIERI DMD

Provider Business Mailing Address
First Line	:	36 WORTHINGTON AVE
Second Line	:
City	:	BELLMAWR
State	:	NJ
Zip	:	08031-2144
Country	:	US
Telephone Number	:	215-313-7866
Fax Number	:

Provider Business Practice Location Address
First Line	:	1911 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-2216
Country	:	US
Telephone Number	:	215-465-6060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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