Pablo Martin Ruck Troncoso

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401415725 Issued in VA

Practice address

4379 Ridgewood Center Dr Ste 102
Woodbridge, VA 22192-8323

Phone

(703) 680-7950

NPI assigned

Feb 1, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dumfries Dental Associates

  • General Practice Dentistry
  • Dumfries, VA
  • NPI 1326395930
  NPD (past)
• Potomac River Orthodontics PLLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Manassas, VA
  • NPI 1730876764
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585008000000",
    "number": "1023476363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15386 GUNSMITH TER",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221913928",
            "telephone_number": "571-338-3907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4379 RIDGEWOOD CENTER DR STE 102",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221928323",
            "telephone_number": "703-680-7950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUCK TRONCOSO",
        "first_name": "PABLO",
        "middle_name": "MARTIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-01",
        "last_updated": "2020-03-24",
        "certification_date": "2020-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401415725",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Rowley, PA-C
• Royal Healthcare Services LLC
• Royalty Health Services Inc
• Pamela Jean Royalty, LCSW
• Felicita Jeannette Rubio
• Dalton Lakota Rudd, LCSW-S
• Drusilla Euphrates Aanique Ruffin
• Seth Rumbley, LCSW
• Jennifer M-E Runner, RESIDENT IN MFT
• Abigail Yvonne Runyans, PA-C

• General Practice Dentistry in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.