Provider Demographics
NPI:1932272580
Name:URUKALO, RISTA (DDS)
Entity type:Individual
Prefix:MRS
First Name:RISTA
Middle Name:
Last Name:URUKALO
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 1:363 CYANNA CT
Mailing Address - Street 2:
Mailing Address - City:LAKESHORE
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N8N5H1
Mailing Address - Country:CA
Mailing Address - Phone:519-979-6188
Mailing Address - Fax:
Practice Address - Street 1:4201 SAINT ANTOINE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-993-0831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI16642122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist