Provider Demographics
NPI:1134572498
Name:RUZANOV, MAKSYM (DMD)
Entity type:Individual
Prefix:
First Name:MAKSYM
Middle Name:
Last Name:RUZANOV
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 1:1505 MALLARD LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3750
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3909 E BAY DR STE 205
Practice Address - Street 2:
Practice Address - City:HOLMES BEACH
Practice Address - State:FL
Practice Address - Zip Code:34217-1990
Practice Address - Country:US
Practice Address - Phone:941-778-2204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22016122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist