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General NPI Number Information
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NPI Number | 1376921312
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Entity Type | Individual
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Provider Name | MICHAEL SCOTT RUSZKOWSKI D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2015
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Last Update Date | 09/28/2016
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Provider Practice Location Address
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Address Line | 3768 BROOKFIELD DR
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City | HUDSONVILLE
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State | MI
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Zip | 49426-9028
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Country | US
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Telephone | 269-655-6356
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Fax |
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Provider Business Mailing Address
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Address Line | 3768 BROOKFIELD DR
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City | HUDSONVILLE
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State | MI
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Zip | 49426-9028
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Country | US
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Telephone | 269-655-6356
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901021998
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License Number State | MI
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