Provider Demographics
NPI:1427620863
Name:RUDER, RICHARD EDMUND (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:EDMUND
Last Name:RUDER
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 1:150 W SEQUIM BAY RD
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-8406
Mailing Address - Country:US
Mailing Address - Phone:360-565-5066
Mailing Address - Fax:360-504-2237
Practice Address - Street 1:150 W SEQUIM BAY RD
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-8406
Practice Address - Country:US
Practice Address - Phone:360-565-5066
Practice Address - Fax:360-504-2237
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61171119122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE61171119OtherDENTIST