Provider Demographics
NPI:1295291839
Name:IRSHEID, RUWA
Entity type:Individual
Prefix:
First Name:RUWA
Middle Name:
Last Name:IRSHEID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SW ARCHER RD # D7-19
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0444
Mailing Address - Country:US
Mailing Address - Phone:352-273-5700
Mailing Address - Fax:352-846-2891
Practice Address - Street 1:1600 SW ARCHER RD # D7-19
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0444
Practice Address - Country:US
Practice Address - Phone:352-273-5700
Practice Address - Fax:352-846-2891
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDRPM1988390200000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program