Provider Demographics
NPI:1407023534
Name:RUGGLES, PATSY G (RDH)
Entity Type:Individual
Prefix:MRS
First Name:PATSY
Middle Name:G
Last Name:RUGGLES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 HARLOW LN
Mailing Address - Street 2:#4
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537
Mailing Address - Country:US
Mailing Address - Phone:970-962-9988
Mailing Address - Fax:970-962-6762
Practice Address - Street 1:1323 HARLOW LN
Practice Address - Street 2:#4
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537
Practice Address - Country:US
Practice Address - Phone:970-962-9988
Practice Address - Fax:970-962-6762
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO201680122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO64853331Medicaid