Provider Demographics
NPI:1629192851
Name:RUETZ-SMITH, SHARON R (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:R
Last Name:RUETZ-SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 ABER DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-4401
Mailing Address - Country:US
Mailing Address - Phone:262-534-6514
Mailing Address - Fax:
Practice Address - Street 1:511 ABER DR
Practice Address - Street 2:SUITE B
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185-4401
Practice Address - Country:US
Practice Address - Phone:262-534-6514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3476-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice