Provider Demographics
NPI:1790811206
Name:RUTECKI, RICHARD JOSEPH JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:RUTECKI
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 MIDLAND PKWY APT 720
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8797
Mailing Address - Country:US
Mailing Address - Phone:843-303-2891
Mailing Address - Fax:866-472-4284
Practice Address - Street 1:597 OLD MOUNT HOLLY RD
Practice Address - Street 2:SUITE 109
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-2831
Practice Address - Country:US
Practice Address - Phone:843-569-8795
Practice Address - Fax:843-569-8797
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2021-06-18
Deactivation Date:2021-05-19
Deactivation Code:
Reactivation Date:2021-06-18
Provider Licenses
StateLicense IDTaxonomies
SCSC 41471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice