Provider Demographics
NPI:1336542398
Name:RUDER, REESE (DDS)
Entity Type:Individual
Prefix:
First Name:REESE
Middle Name:
Last Name:RUDER
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 1:66 N HOLIDAY RD
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-6936
Mailing Address - Country:US
Mailing Address - Phone:850-213-2626
Mailing Address - Fax:888-959-7745
Practice Address - Street 1:66 N HOLIDAY RD
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-6936
Practice Address - Country:US
Practice Address - Phone:850-213-2626
Practice Address - Fax:888-959-7745
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 20813122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist