Provider Demographics
NPI:1679691042
Name:RUGELEY, JOHN KELLY (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KELLY
Last Name:RUGELEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8240 N MO PAC EXPY
Mailing Address - Street 2:SUITE 285
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8840
Mailing Address - Country:US
Mailing Address - Phone:512-343-2758
Mailing Address - Fax:512-343-2941
Practice Address - Street 1:8240 N MO PAC EXPY
Practice Address - Street 2:SUITE 285
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8840
Practice Address - Country:US
Practice Address - Phone:512-343-2758
Practice Address - Fax:512-343-2941
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX159471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice