Provider Demographics
NPI:1255825675
Name:RUOPP, BRENTON PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENTON
Middle Name:PATRICK
Last Name:RUOPP
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 1:2440 S BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63144-2320
Mailing Address - Country:US
Mailing Address - Phone:314-696-1544
Mailing Address - Fax:
Practice Address - Street 1:2440 S BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-2320
Practice Address - Country:US
Practice Address - Phone:314-696-1544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180202881223G0001X, 122300000X
IL0190329711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice