Provider Demographics
NPI:1871509109
Name:RUCKMAN, RALPH KARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:KARL
Last Name:RUCKMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4801 S CLIFF AVE
Mailing Address - Street 2:STE. 208
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-7015
Mailing Address - Country:US
Mailing Address - Phone:816-373-4554
Mailing Address - Fax:816-379-0011
Practice Address - Street 1:4801 S CLIFF AVE
Practice Address - Street 2:STE 208
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-7015
Practice Address - Country:US
Practice Address - Phone:816-373-8002
Practice Address - Fax:816-379-0011
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO141921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO14192OtherDELTA
MO138920OtherUNITED CONCORDIA
MO242220OtherTRIGON
MO10859OtherBLUE CROSS BLUE SHIELD