Provider Demographics
NPI:1427260009
Name:KEVIN D RUCINSKI DDS
Entity type:Organization
Organization Name:KEVIN D RUCINSKI DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:RUCINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-821-9222
Mailing Address - Street 1:188 PINE BLUFFS
Mailing Address - Street 2:
Mailing Address - City:ROSCOMMON
Mailing Address - State:MI
Mailing Address - Zip Code:48653
Mailing Address - Country:US
Mailing Address - Phone:989-821-9222
Mailing Address - Fax:989-821-4981
Practice Address - Street 1:188 PINE BLUFFS
Practice Address - Street 2:
Practice Address - City:ROSCOMMON
Practice Address - State:MI
Practice Address - Zip Code:48653
Practice Address - Country:US
Practice Address - Phone:989-821-9222
Practice Address - Fax:989-821-4981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14132122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4529944Medicaid