Provider Demographics
NPI:1831107812
Name:ALLEN S RUANE DDS PC
Entity Type:Organization
Organization Name:ALLEN S RUANE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:SNYDER
Authorized Official - Last Name:RUANE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-333-1770
Mailing Address - Street 1:3159 RAWLE ST
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-2618
Mailing Address - Country:US
Mailing Address - Phone:215-333-1770
Mailing Address - Fax:
Practice Address - Street 1:3159 RAWLE ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-2618
Practice Address - Country:US
Practice Address - Phone:215-333-1770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022340L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
124914OtherBCBC UCCI