Provider Demographics
NPI:1518778489
Name:RUDDY, LINDA JO (RDH)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JO
Last Name:RUDDY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:JO
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7097 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-9155
Mailing Address - Country:US
Mailing Address - Phone:920-379-9185
Mailing Address - Fax:
Practice Address - Street 1:550 CITY CTR
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-4830
Practice Address - Country:US
Practice Address - Phone:920-731-7445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5630-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist