Provider Demographics
NPI:1952313389
Name:RUDDY, RICHARD LAWRENCE (DDS)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LAWRENCE
Last Name:RUDDY
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 1:24 MAPLE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4259
Mailing Address - Country:US
Mailing Address - Phone:516-764-5800
Mailing Address - Fax:
Practice Address - Street 1:24 MAPLE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4289
Practice Address - Country:US
Practice Address - Phone:516-764-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29247122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist