Provider Demographics
NPI:1366595308
Name:RUGGIERO, JEFFREY (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:RUGGIERO
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 1:205 BROWERTOWN RD
Mailing Address - Street 2:SUITE 004
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2671
Mailing Address - Country:US
Mailing Address - Phone:973-256-0275
Mailing Address - Fax:973-256-8003
Practice Address - Street 1:205 BROWERTOWN RD
Practice Address - Street 2:SUITE 004
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-2671
Practice Address - Country:US
Practice Address - Phone:973-256-0275
Practice Address - Fax:973-256-8003
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0195691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice