Provider Demographics
NPI:1841561651
Name:RUDDLE, CLIFFORD J (DDS)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:J
Last Name:RUDDLE
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 1:122 S PATTERSON AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-4020
Mailing Address - Country:US
Mailing Address - Phone:805-964-8838
Mailing Address - Fax:805-965-8253
Practice Address - Street 1:227 LAS ALTURAS RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-2104
Practice Address - Country:US
Practice Address - Phone:805-965-3684
Practice Address - Fax:805-965-8253
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA245011223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics