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General NPI Number Information
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NPI Number | 1356576656
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Entity Type | Individual
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Provider Name | KRISTOPHER NEIL RUEBSAMEN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/15/2009
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Last Update Date | 05/16/2009
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Provider Practice Location Address
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Address Line | 20103 OLD SCENIC HWY BUILDING #2, SUITE A
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City | ZACHARY
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State | LA
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Zip | 70791-7300
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Country | US
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Telephone | 504-481-0707
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Fax |
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Provider Business Mailing Address
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Address Line | 13142 DUTCHTOWN LAKES DR
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City | GEISMAR
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State | LA
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Zip | 70734-3048
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Country | US
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Telephone | 504-481-0707
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 5821
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License Number State | LA
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