Provider Demographics
NPI:1851322531
Name:RUCKERT, ERIC WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WILLIAM
Last Name:RUCKERT
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 1:880 WESTFALL RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2611
Mailing Address - Country:US
Mailing Address - Phone:585-473-1700
Mailing Address - Fax:585-271-0806
Practice Address - Street 1:880 WESTFALL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2611
Practice Address - Country:US
Practice Address - Phone:585-473-1700
Practice Address - Fax:585-271-0806
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0344991223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00855078Medicaid
NY7877EROtherEXCELLUS
NY5448185OtherAETNA ID NUMBER
NYP010034499OtherBLUE CHOICE ID
NY102051ATOtherPREFERRED CARE
NY39849BMedicare ID - Type Unspecified
NY00855078Medicaid