=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639062482
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FRANK PAUL RUFFINO IV DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2025
-----------------------------------------------------
Last Update Date | 05/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 51333 MOUND RD
-----------------------------------------------------
City | SHELBY TOWNSHIP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48316-4344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-799-4240
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5603 BRADBURY RUN
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48094-1065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-531-3180
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 2901602513
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------