Provider Demographics
NPI:1073689147
Name:RUUD, JOHN O (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:O
Last Name:RUUD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 N CHELAN AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2104
Mailing Address - Country:US
Mailing Address - Phone:509-662-5722
Mailing Address - Fax:509-662-0752
Practice Address - Street 1:245 N CHELAN AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2104
Practice Address - Country:US
Practice Address - Phone:509-662-5722
Practice Address - Fax:509-662-0752
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00002973122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist