Provider Demographics
NPI:1194874263
Name:RUOPP AND RUOPP DDS PC
Entity type:Organization
Organization Name:RUOPP AND RUOPP DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:RUOPP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-334-8884
Mailing Address - Street 1:1818 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4508
Mailing Address - Country:US
Mailing Address - Phone:573-334-8884
Mailing Address - Fax:573-334-7656
Practice Address - Street 1:1818 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4508
Practice Address - Country:US
Practice Address - Phone:573-334-8884
Practice Address - Fax:573-334-7656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0125441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2015OtherBLUE CROSS BLUE SHIELD
838019OtherUNITED CONCORDIA