Healthcare Provider Details

I. General information

NPI: 1750567764
Provider Name (Legal Business Name): DANIELLE RENAY RUSKIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 01/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30426 MILFORD RD
NEW HUDSON MI
48165-8583
US

IV. Provider business mailing address

30426 MILFORD RD
NEW HUDSON MI
48165-8583
US

V. Phone/Fax

Practice location:
  • Phone: 248-446-0288
  • Fax: 248-446-5257
Mailing address:
  • Phone: 248-446-0288
  • Fax: 248-446-5257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901017710
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: