Provider Demographics
NPI:1043221393
Name:RUPPEL, LINDA JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:JEAN
Last Name:RUPPEL
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 1:7669 EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9018
Mailing Address - Country:US
Mailing Address - Phone:208-377-5523
Mailing Address - Fax:208-377-0352
Practice Address - Street 1:7669 EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9018
Practice Address - Country:US
Practice Address - Phone:208-377-5523
Practice Address - Fax:208-377-0352
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD2032PR1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID66D2032Medicaid
IDD22551MMedicare ID - Type Unspecified
ID66D2032Medicaid