Provider Demographics
NPI:1073038519
Name:MA, RUIDAN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:RUIDAN
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 W 34TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2008
Mailing Address - Country:US
Mailing Address - Phone:615-669-9451
Mailing Address - Fax:
Practice Address - Street 1:1015 W 34TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2008
Practice Address - Country:US
Practice Address - Phone:615-669-9451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-06
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1016351223G0001X, 1223X0400X
IL0190318471223X0400X
TX385531223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101635OtherCALIFORNIA DENTAL BOARD
TX38553OtherTEXAS STATE BOARD OF DENTAL EXAMINERS