Provider Demographics
NPI:1801802715
Name:RUESINK, DONNA MCCOY (DDS)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MCCOY
Last Name:RUESINK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 SPICEWOOD SPRINGS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8505
Mailing Address - Country:US
Mailing Address - Phone:512-345-3955
Mailing Address - Fax:
Practice Address - Street 1:4505 SPICEWOOD SPRINGS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8505
Practice Address - Country:US
Practice Address - Phone:512-345-3955
Practice Address - Fax:
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
TX149851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice