Dwight Antonio Ruddock, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

14888 Issued in TX

Practice address

719 Hemphill St
Fort Worth, TX 76104-3106

Phone

(817) 335-3806

Fax

(817) 338-1681

NPI assigned

Aug 14, 2006

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 TX

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

State licenses

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275546780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 HEMPHILL ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043106",
            "telephone_number": "817-335-3806",
            "fax_number": "817-338-1681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 HEMPHILL ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043106",
            "telephone_number": "817-335-3806",
            "fax_number": "817-338-1681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDDOCK",
        "first_name": "DWIGHT",
        "middle_name": "ANTONIO",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "14888",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Mae Rubio, FNP
• Natalie Marie Rubio, ND
• James Rucker, MS
• Katherine Rudd, RDN
• Rayney Rudd, RBT
• Samuel Rude, PMHNP
• Carissa Rudeau
• Trina Angel Rudeski-Rohr, MD
• Diane Rudisaile, LCSW
• Julio Alberto Rueda Escobar

• General Practice Dentistry in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.