Provider Demographics
NPI:1295954089
Name:RUTER, KEITH R (DDS)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:R
Last Name:RUTER
Suffix:
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 1:510 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORRESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61030-9532
Mailing Address - Country:US
Mailing Address - Phone:815-938-2502
Mailing Address - Fax:
Practice Address - Street 1:208 N WALNUT AVE
Practice Address - Street 2:
Practice Address - City:FORRESTON
Practice Address - State:IL
Practice Address - Zip Code:61030-9330
Practice Address - Country:US
Practice Address - Phone:815-938-2575
Practice Address - Fax:815-938-2363
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice