Kenneth Brian Rusanowski, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DD1585 Issued in NM

Practice address

2 Calle Medico
Ste 2
Santa Fe, NM 87505

Phone

(505) 988-2611

Fax

(505) 820-0397

NPI assigned

Jan 18, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

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

State licenses

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174675185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 CALLE MEDICO",
            "address_2": "STE 2",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "87505",
            "telephone_number": "505-988-2611",
            "fax_number": "505-820-0397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 CALLE MEDICO",
            "address_2": "STE 2",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "87505",
            "telephone_number": "505-988-2611",
            "fax_number": "505-820-0397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSANOWSKI",
        "first_name": "KENNETH",
        "middle_name": "BRIAN",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NM",
            "license": "DD1585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gloria Ruiz, MD
• Teresita Ruiz, CHW
• Catherine Rule, CRC
• Running Bear Rescue,Inc. (Rocky Mountain EMS)
• Richard Brandon Runyon, O.D.
• Russell Canfield MD PC (360 Medicine)
• Dexter Russell
• Rana Wynne Russell, FNP
• Dolce Russo, N.P.
• Judy Ellen Rust-Huerta, LISW

• Periodontics in Santa Fe, NM
• Providers in Santa Fe, NM by specialty
• Periodontics in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.