Provider Demographics
NPI:1013018563
Name:RUCKERT, MONICA LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:LYNN
Last Name:RUCKERT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2754 DARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-1051
Mailing Address - Country:US
Mailing Address - Phone:724-891-1022
Mailing Address - Fax:724-891-1026
Practice Address - Street 1:2754 DARLINGTON RD
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-1051
Practice Address - Country:US
Practice Address - Phone:724-891-1022
Practice Address - Fax:724-891-1026
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 028130-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA61079OtherPA BLUE SHIELD/UNITED CON