Provider Demographics
NPI:1831389246
Name:RJR DENTISTRY LLC
Entity type:Organization
Organization Name:RJR DENTISTRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RUTECKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-569-8795
Mailing Address - Street 1:597 OLD MOUNT HOLLY RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-2831
Mailing Address - Country:US
Mailing Address - Phone:843-569-8795
Mailing Address - Fax:843-569-8797
Practice Address - Street 1:597 OLD MOUNT HOLLY RD
Practice Address - Street 2:SUITE 209
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-2831
Practice Address - Country:US
Practice Address - Phone:843-569-8795
Practice Address - Fax:843-569-8797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC41371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty