Holdunn Rutkoski, DMD, MPH

Primary specialty

DentistTaxonomy code 122300000X

License

DN122833 Issued in GA

Practice address

303 Fraser Dr
Hinesville, GA 31313-3712

Phone

(912) 877-2227

Fax

(912) 877-2332

NPI assigned

Jun 23, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Diversity Health Center Inc.

  • Federally Qualified Health Center (FQHC)
  • Hinesville, GA
  • NPI 1326594714
  Medicare reassignment NPD
• J.C. Lewis Primary Healthcare Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Savannah, GA
  • NPI 1922301472
  Medicare reassignment NPD
• Diversity Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Hinesville, GA
  • NPI 1720108590
  NPD
• Diversity Health Center Inc.

  • Community/Retail Pharmacy
  • Ludowici, GA
  • NPI 1265274120
  NPD
• J C Lewis Primary Health Care Center

  • Pharmacy
  • Savannah, GA
  • NPI 1508453994
  NPD
• Diversity Health Center Inc.

  • Federally Qualified Health Center (FQHC)
  • Jesup, GA
  • NPI 1518508613
  NPD (past)

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

{
    "created_epoch": "1592870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687996800000",
    "number": "1154947349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1306 RIDDICK LN",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314074078",
            "telephone_number": "801-651-5642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 FRASER DR",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313133712",
            "telephone_number": "912-877-2227",
            "fax_number": "912-877-2332"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5 Mall Anx",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314064738",
            "country_code": "US",
            "telephone_number": "912-495-8887",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUTKOSKI",
        "first_name": "HOLDUNN",
        "credential": "DMD, MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-23",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1858696",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN122833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Hinesville, GA
• Providers in Hinesville, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.