Keith R. Ruter, D.D.S.
Individual provider Active NPI General Practice Dentistry · Forreston, IL
NPI 1295954089 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1295954089
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- Practice address
- 208 N Walnut Ave
Forreston, IL 61030-9330 - Phone
- (815) 938-2575
- Fax
- (815) 938-2363
- NPI assigned
- Apr 24, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019019570 | IL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shady Oak Dental LLC Oral and Maxillofacial Surgeons of Northwest Il | Past |
Accepting new patients | |
| Forreston Dental | General Practice | Past | Accepting new patients |
| Autumn Dental of Mokena LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | IL | Yes |
Addresses
Primary practice location
208 N Walnut Ave
Forreston, IL 61030-9330
Mailing address
510 S 5TH Ave
Forreston, IL 61030-9532
Phone (815) 938-2502
Other providers in Forreston, IL
- Forreston Fire Protection District
- Forrestville Valley U S D 221
- Freeport Regional Health Care Foundation
- Katherine Kalina
- April Lynn Moore
- Schoaf Family Chiropractic LLC
- Daniel Patrick Schoaf
- Shady Oak Dental LLC Oral and Maxillofacial Surgeons of Northwest Il
- Marisa Vogt
All providers in Forreston, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.