Provider Demographics
NPI:1083751911
Name:RUFFNER, JUSTIN WARREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:WARREN
Last Name:RUFFNER
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:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:NORTH CARVER
Mailing Address - State:MA
Mailing Address - Zip Code:02355-0003
Mailing Address - Country:US
Mailing Address - Phone:240-818-2212
Mailing Address - Fax:
Practice Address - Street 1:516 HAWTHORN ST
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3733
Practice Address - Country:US
Practice Address - Phone:508-997-6617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice