Provider Demographics
NPI:1659709145
Name:W ERICK RUPPRECHT DDS PLLC
Entity Type:Organization
Organization Name:W ERICK RUPPRECHT DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:RUPPRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-957-0303
Mailing Address - Street 1:2554 WOODMEADOW DR SE STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8033
Mailing Address - Country:US
Mailing Address - Phone:616-957-0303
Mailing Address - Fax:616-957-2732
Practice Address - Street 1:2554 WOODMEADOW DR SE STE A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8033
Practice Address - Country:US
Practice Address - Phone:616-957-0303
Practice Address - Fax:616-957-2732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty