Provider Demographics
NPI:1710107578
Name:RUPRIGHT, ADRIENNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:
Last Name:RUPRIGHT
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 1:5327 S BEND DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-1681
Mailing Address - Country:US
Mailing Address - Phone:260-444-5510
Mailing Address - Fax:260-755-5933
Practice Address - Street 1:5327 S BEND DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1681
Practice Address - Country:US
Practice Address - Phone:260-444-5510
Practice Address - Fax:260-755-5933
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010760A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist