Provider Demographics
NPI:1306995790
Name:RUOCCO, SANDRA MCDANIEL (DDS)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:MCDANIEL
Last Name:RUOCCO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8418 NEWTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-8302
Mailing Address - Country:US
Mailing Address - Phone:704-843-2880
Mailing Address - Fax:704-843-1652
Practice Address - Street 1:8418 NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-8302
Practice Address - Country:US
Practice Address - Phone:704-843-2880
Practice Address - Fax:704-843-1652
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice