Active NPI
Ruslan Fomenko, DMD
- General Practice Dentistry
- Traverse City, MI
National Provider Identifier
1548002256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2901602281
- Practice address
- 2815 Garfield Rd N
Traverse City, MI 49686-5005 - Phone
- (231) 947-4380
- NPI assigned
- Jun 12, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2901602281 | MI | Primary |
Addresses
Primary practice location
2815 Garfield Rd N
Traverse City, MI 49686-5005
Mailing address
2815 Garfield Rd N
Traverse City, MI 49686-5005
Phone (231) 947-4380
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901602281 | MI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1718150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718150400000",
"number": "1548002256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2815 GARFIELD RD N",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496865005",
"telephone_number": "231-947-4380"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2815 GARFIELD RD N",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496865005",
"telephone_number": "231-947-4380"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOMENKO",
"first_name": "RUSLAN",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-06-12",
"last_updated": "2024-06-12",
"certification_date": "2024-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MI",
"license": "2901602281",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Traverse City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.