Provider Demographics
NPI:1447313838
Name:RUFFALO, RICHARD C (DMD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:RUFFALO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 MCLAUGHLIN RUN RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-3100
Mailing Address - Country:US
Mailing Address - Phone:412-257-1150
Mailing Address - Fax:412-257-3758
Practice Address - Street 1:1580 MCLAUGHLIN RUN RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-3100
Practice Address - Country:US
Practice Address - Phone:412-257-1150
Practice Address - Fax:412-257-3758
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020682L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00807874Medicaid