Shane Ruggless, D.M.D.
Individual provider Active NPI General Practice Dentistry · Auburn, IL
NPI 1659636785 · NPPES record last updated Jul 4, 2012
Key facts
- NPI
- 1659636785
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 019.029024 (IL)
- Practice address
- 500 E Jackson St
Auburn, IL 62615-9787 - Phone
- (217) 438-3721
- NPI assigned
- Jul 4, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.029024 | IL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Delivering Smiles LTD | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019.029024 | IL | Yes |
Addresses
Primary practice location
500 E Jackson St
Auburn, IL 62615-9787
Mailing address
500 E Jackson St
Auburn, IL 62615-9787
Phone (217) 438-3721
Other providers in Auburn, IL
- Kessler Chiropractic Clinic
- Kayla Kristine Meyer
- Kevin Monahan
- Lisa Suzanne Newquist
- Andrea Elise O'Dell
- Glen A Weisgerber
All providers in Auburn, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 4, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.