Provider Demographics
NPI:1013326859
Name:RUANA, NICHOLAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:RUANA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AREA SUPPORT GROUP - KUWAIT
Mailing Address - Street 2:DENTAL
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09366-9998
Mailing Address - Country:US
Mailing Address - Phone:702-217-7343
Mailing Address - Fax:
Practice Address - Street 1:AREA SUPPORT GROUP - KUWAIT
Practice Address - Street 2:DENTAL
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09366-9998
Practice Address - Country:US
Practice Address - Phone:702-217-7343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6534122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist