Marykate Rusnak, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

12010669A Issued in IN

Practice address

3600 Mitchell Drive, Suite 40
Mountain Kids Pediatric Dentistry
Fort Collins, CO 80525

Phone

(970) 224-3600

Fax

(970) 568-8577

NPI assigned

Oct 11, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344297600000",
    "number": "1033207329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 MITCHELL DRIVE, SUITE 40",
            "address_2": "MOUNTAIN KIDS PEDIATRIC DENTISTRY",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "80525",
            "telephone_number": "970-224-3600",
            "fax_number": "970-568-8577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 MITCHELL DRIVE, SUITE 40",
            "address_2": "MOUNTAIN KIDS PEDIATRIC DENTISTRY",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "80525",
            "telephone_number": "970-224-3600",
            "fax_number": "970-568-8577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSNAK",
        "first_name": "MARYKATE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-11",
        "last_updated": "2012-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IN",
            "license": "12010669A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200826610",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brenna R Rush, LCSW
• Rodney Rush II
• Ryan Kent Rush, D.D.S.
• Jenna Rushton, LCSW
• Sarah Elizabeth Rushton, CCC-SLP
• Michael P Rusnak, MD
• Russell Family Clinic, LLC
• Charles Edward Russell, MA, LPC
• Dianne Russell, RMT
• Joshua Russell, D.C.

• Pediatric Dentistry in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Pediatric Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.