Provider Demographics
NPI:1235303439
Name:RUDER, BENJAMIN DANELSKI (DDS)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:DANELSKI
Last Name:RUDER
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 1:2370 N 59TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2214
Mailing Address - Country:US
Mailing Address - Phone:208-818-0308
Mailing Address - Fax:
Practice Address - Street 1:222 LILLY RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5031
Practice Address - Country:US
Practice Address - Phone:360-459-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00011177122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist