Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 201680 | CO |
NPI | 1407023534 |
---|---|
Provider Name | Mrs. Patsy G Ruggles |
First Address | Loveland, CO 80537 |
Second Address | Loveland, CO 80537 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2008 |
Last Update Date | 08/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64853331 | (05) | CO |