Provider Demographics
NPI:1760637532
Name:RUYLE, BONNIE L
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:RUYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 CALLE PAVA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6320
Mailing Address - Country:US
Mailing Address - Phone:505-690-9846
Mailing Address - Fax:
Practice Address - Street 1:2322 CALLE PAVA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6320
Practice Address - Country:US
Practice Address - Phone:505-690-9846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1720122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist