Provider Demographics
NPI:1164689923
Name:RUEL, JON A (DMD, MSCD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:A
Last Name:RUEL
Suffix:
Gender:M
Credentials:DMD, MSCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 KING CHARLES DR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-1343
Mailing Address - Country:US
Mailing Address - Phone:401-683-5990
Mailing Address - Fax:
Practice Address - Street 1:21 KING CHARLES DR.
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-6613
Practice Address - Country:US
Practice Address - Phone:401-683-5990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA124871223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics