Provider Demographics
NPI:1598815359
Name:RUFFNER, TIMOTHY EARL (DDS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:EARL
Last Name:RUFFNER
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 1:241 FORSYTHE DR
Mailing Address - Street 2:
Mailing Address - City:REDWOOD VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95470-9500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1155 S MAIN ST
Practice Address - Street 2:SUITE 107
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-4336
Practice Address - Country:US
Practice Address - Phone:707-459-0766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA033985122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3398501OtherDENTI-CAL PROVIDER NUMBER
CAD3398501OtherDENTI-CAL PROVIDER NUMBER