Provider Demographics
NPI:1184821779
Name:RUELLA, MICHAEL K (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:K
Last Name:RUELLA
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 1:375 ROUTE 199
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-2417
Mailing Address - Country:US
Mailing Address - Phone:845-758-2300
Mailing Address - Fax:845-758-9709
Practice Address - Street 1:15 OLD FARM RD
Practice Address - Street 2:
Practice Address - City:RED HOOK
Practice Address - State:NY
Practice Address - Zip Code:12571-2417
Practice Address - Country:US
Practice Address - Phone:845-758-1300
Practice Address - Fax:845-758-5535
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0291801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice