Healthcare Provider Details

I. General information

NPI: 1710997176
Provider Name (Legal Business Name): JANET LYNN RUCKER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 W MICHIGAN ST
INDIANAPOLIS IN
46202-5211
US

IV. Provider business mailing address

380 W MARKET ST
CRAWFORDSVILLE IN
47933-1632
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-7433
  • Fax:
Mailing address:
  • Phone: 765-362-1906
  • Fax: 765-359-0688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12008139A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: