Provider Demographics
NPI:1235354382
Name:KEVIN B RUCINSKI DDS PC
Entity Type:Organization
Organization Name:KEVIN B RUCINSKI DDS PC
Other - Org Name:ROSCOMMON FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:RUCINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-821-9222
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
Practice Address - Street 2:
Practice Address - City:ROSCOMMON
Practice Address - State:MI
Practice Address - Zip Code:48653
Practice Address - Country:US
Practice Address - Phone:989-821-9222
Practice Address - Fax:989-821-4981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14132122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty