Healthcare Provider Details

I. General information

NPI: 1477444883
Provider Name (Legal Business Name): AMELIA JOY RUGER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E ALCOTT ST
KALAMAZOO MI
49001-6144
US

IV. Provider business mailing address

6294 APPLEGROVE LN
PORTAGE MI
49024-9024
US

V. Phone/Fax

Practice location:
  • Phone: 269-349-2641
  • Fax:
Mailing address:
  • Phone: 269-568-5374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902021358
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: