Provider Demographics
NPI:1033485164
Name:RUCINSKI, KEVIN B (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:B
Last Name:RUCINSKI
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 1:188 PINE BLUFFS RD
Mailing Address - Street 2:
Mailing Address - City:ROSCOMMON
Mailing Address - State:MI
Mailing Address - Zip Code:48653-8328
Mailing Address - Country:US
Mailing Address - Phone:989-821-9222
Mailing Address - Fax:989-821-4981
Practice Address - Street 1:188 PINE BLUFFS RD
Practice Address - Street 2:
Practice Address - City:ROSCOMMON
Practice Address - State:MI
Practice Address - Zip Code:48653-8328
Practice Address - Country:US
Practice Address - Phone:989-821-9222
Practice Address - Fax:989-821-4981
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14132122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist