Travis C. Rudd, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DD3881 Issued in NM

Practice address

10151 Montgomery Blvd NE
Suite 2D
Albuquerque, NM 87111-3670

Phone

(505) 292-3400

Fax

(505) 292-7124

NPI assigned

Jan 29, 2009

Last updated

Sep 25, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Dec 29, 2016 through Dec 29, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: trudd10776@ahs.direct-ci.com

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.

• Bear Canyon Oral & Facial Surgery

  • Ambulatory Surgical Clinic/Center
  • Albuquerque, NM
  • NPI 1871922807
  NPD (past) Authorized official
• Steven B. Roholt, DDS, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Albuquerque, NM
  • NPI 1427004340
  NPD (past)

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

{
    "created_epoch": "1233187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380067200000",
    "number": "1255579264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10151 MONTGOMERY BLVD NE",
            "address_2": "SUITE 2D",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871113670",
            "telephone_number": "505-292-3400",
            "fax_number": "505-292-7124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10151 MONTGOMERY BLVD NE",
            "address_2": "SUITE 2D",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871113670",
            "telephone_number": "505-292-3400",
            "fax_number": "505-292-7124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDD",
        "first_name": "TRAVIS",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-01-29",
        "last_updated": "2013-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NM",
            "license": "DD3881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nathaniel Rubio
• Rani Rubio, LCSW
• Deborah Rubolino, LCSW
• Thomas Ruby, PHD
• David Rudd
• Jeremy Ruddell
• Matthew Ruder
• Leah A Rudnick, MD
• Lance A. Rudolph, M.D.
• Lori Rudolph, PH.D

• Oral and Maxillofacial Surgery (Dentist) in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Oral and Maxillofacial Surgery (Dentist) in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2013; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.