Provider Demographics
NPI:1710997176
Name:RUCKER, JANET LYNN (DDS)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LYNN
Last Name:RUCKER
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 1:380 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-1632
Mailing Address - Country:US
Mailing Address - Phone:765-362-1906
Mailing Address - Fax:765-359-0688
Practice Address - Street 1:380 W MARKET ST
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-1632
Practice Address - Country:US
Practice Address - Phone:765-362-1906
Practice Address - Fax:765-359-0688
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008139A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice