Provider Demographics
NPI:1366656985
Name:RUESCH, WENDY (RDH,CDHC)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:
Last Name:RUESCH
Suffix:
Gender:F
Credentials:RDH,CDHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 PARKLAND LN
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-7546
Mailing Address - Country:US
Mailing Address - Phone:715-421-8911
Mailing Address - Fax:715-421-8962
Practice Address - Street 1:184 2ND ST N
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-4162
Practice Address - Country:US
Practice Address - Phone:715-421-8911
Practice Address - Fax:715-421-8962
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3090-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist