Provider Demographics
NPI:1003064247
Name:RUETER, KATHLEEN E (DMD, MS, LLC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:E
Last Name:RUETER
Suffix:
Gender:F
Credentials:DMD, MS, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 SW UPPER TERRACE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1582
Mailing Address - Country:US
Mailing Address - Phone:541-388-7421
Mailing Address - Fax:
Practice Address - Street 1:499 SW UPPER TERRACE DR
Practice Address - Street 2:SUITE B
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1582
Practice Address - Country:US
Practice Address - Phone:541-388-7421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD89051223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics