Provider Demographics
NPI:1922187582
Name:RUDDY, SARA ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:ELIZABETH
Last Name:RUDDY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:ELIZABETH
Other - Last Name:STOIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3083 COOLIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-3523
Mailing Address - Country:US
Mailing Address - Phone:248-547-5115
Mailing Address - Fax:248-547-5613
Practice Address - Street 1:3083 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-3523
Practice Address - Country:US
Practice Address - Phone:248-547-5115
Practice Address - Fax:248-547-5613
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018909122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist