Provider Demographics
NPI:1275683591
Name:RUEHL, TERESA LYNN (DDS)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:RUEHL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3038
Mailing Address - Country:US
Mailing Address - Phone:307-332-2201
Mailing Address - Fax:
Practice Address - Street 1:850 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3038
Practice Address - Country:US
Practice Address - Phone:307-332-2201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-022301122300000X
WY12351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30-022301OtherDENTAL LICENSE
WY1235OtherDENTAL LICENSE
WY1477849289Medicaid
WY1477849289Medicaid