1356469324 NPI number — RUWAIDA G TOOTLA DDS

Table of content: RUWAIDA G TOOTLA DDS (NPI 1356469324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356469324 NPI number — RUWAIDA G TOOTLA DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOOTLA
Provider First Name:
RUWAIDA
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356469324
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1011 N UNIVERSITY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANN ARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48109-1078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-763-7820
Provider Business Mailing Address Fax Number:
734-763-8100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1011 N UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48109-1078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-763-7820
Provider Business Practice Location Address Fax Number:
734-763-8100
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2901018717 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1223G0001X , with the licence number: 2901018717 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4784446 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1958111760 . This is a "BCBS OF MI MED SURGICAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2667574 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: D187170 . This is a "BCBS OF MI DENTAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4784455 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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