Provider Demographics
NPI:1790813129
Name:RUEDA, SANTIAGO (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANTIAGO
Middle Name:
Last Name:RUEDA
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 1:2100 HILDAROSE DR
Mailing Address - Street 2:#3
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5646
Mailing Address - Country:US
Mailing Address - Phone:410-272-1535
Mailing Address - Fax:
Practice Address - Street 1:2100 HILDAROSE DR
Practice Address - Street 2:#3
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5646
Practice Address - Country:US
Practice Address - Phone:410-272-1535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13648122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDMD 13648OtherMD LICENSE