Provider Demographics
NPI:1255438305
Name:GOMES-RUANE, YEDDA M (DMD)
Entity type:Individual
Prefix:DR
First Name:YEDDA
Middle Name:M
Last Name:GOMES-RUANE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 TOWN CENTER BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2909
Mailing Address - Country:US
Mailing Address - Phone:954-384-4560
Mailing Address - Fax:954-384-8303
Practice Address - Street 1:1608 TOWN CENTER BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-2909
Practice Address - Country:US
Practice Address - Phone:954-384-4560
Practice Address - Fax:954-384-8303
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0013072122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist