Provider Demographics
NPI:1639268618
Name:RUDER, FRED E (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:E
Last Name:RUDER
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 1:5399 HIGHWAY 30-A
Mailing Address - Street 2:
Mailing Address - City:SEAGROVE
Mailing Address - State:FL
Mailing Address - Zip Code:32459
Mailing Address - Country:US
Mailing Address - Phone:850-231-3736
Mailing Address - Fax:
Practice Address - Street 1:5399 HIGHWAY 30-A
Practice Address - Street 2:
Practice Address - City:SEAGROVE
Practice Address - State:FL
Practice Address - Zip Code:32459
Practice Address - Country:US
Practice Address - Phone:850-231-3736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN101451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice