Provider Demographics
NPI:1184822710
Name:WRUCK, SARAH J (RDH)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:J
Last Name:WRUCK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26355 274TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLCOMBE
Mailing Address - State:WI
Mailing Address - Zip Code:54745-8765
Mailing Address - Country:US
Mailing Address - Phone:715-595-4788
Mailing Address - Fax:
Practice Address - Street 1:23140 WHITEHALL ROAD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:WI
Practice Address - Zip Code:54747-0125
Practice Address - Country:US
Practice Address - Phone:715-985-2391
Practice Address - Fax:715-985-2581
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5946-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist