Provider Demographics
NPI:1356469324
Name:TOOTLA, RUWAIDA G (DDS)
Entity type:Individual
Prefix:
First Name:RUWAIDA
Middle Name:G
Last Name:TOOTLA
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 1:1011 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-1078
Mailing Address - Country:US
Mailing Address - Phone:734-763-7820
Mailing Address - Fax:734-763-8100
Practice Address - Street 1:1011 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-1078
Practice Address - Country:US
Practice Address - Phone:734-763-7820
Practice Address - Fax:734-763-8100
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018717122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4784446Medicaid
MI1958111760OtherBCBS OF MI MED SURGICAL
OH2667574Medicaid
MID187170OtherBCBS OF MI DENTAL
MI4784455Medicaid