Provider Demographics
NPI:1972661171
Name:RUEGSEGGER, TRACY ANN (DDS PC)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:ANN
Last Name:RUEGSEGGER
Suffix:
Gender:F
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:876 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-2759
Mailing Address - Country:US
Mailing Address - Phone:231-218-7148
Mailing Address - Fax:231-947-8072
Practice Address - Street 1:876 E 8TH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2759
Practice Address - Country:US
Practice Address - Phone:231-947-6483
Practice Address - Fax:231-947-8072
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010186621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice