Provider Demographics
NPI:1356576656
Name:RUEBSAMEN, KRISTOPHER NEIL (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:NEIL
Last Name:RUEBSAMEN
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 1:13142 DUTCHTOWN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:GEISMAR
Mailing Address - State:LA
Mailing Address - Zip Code:70734-3048
Mailing Address - Country:US
Mailing Address - Phone:504-481-0707
Mailing Address - Fax:
Practice Address - Street 1:20103 OLD SCENIC HWY
Practice Address - Street 2:BUILDING #2, SUITE A
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-7300
Practice Address - Country:US
Practice Address - Phone:504-481-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2009-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA58211223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics