Provider Demographics
NPI:1407377898
Name:RUGGIERO, BRIAN LOUIS (DMD, MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:LOUIS
Last Name:RUGGIERO
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5751
Mailing Address - Country:US
Mailing Address - Phone:401-724-7230
Mailing Address - Fax:
Practice Address - Street 1:827 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5751
Practice Address - Country:US
Practice Address - Phone:401-724-7230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN036541223S0112X
MI2901022386390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery