Active NPI
Ronald J Kruske, DDS
- Dentist
- Gladwin, MI
National Provider Identifier
1750483376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 01S374
- Practice address
- 200 West Cedar Ave
Gladwin, MI 48624 - Phone
- (989) 426-6341
- Fax
- (989) 426-6411
- NPI assigned
- Sep 3, 2006
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 01S374 | MI | Primary |
Addresses
Primary practice location
200 West Cedar Ave
Gladwin, MI 48624
Mailing address
200 West Cedar Ave
Gladwin, MI 48624
Phone (989) 426-6341
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2926515 | Medicaid | MI |
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 |
|---|---|---|---|
| 01S374 | MI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mid-Michigan Dental Associates PLC Gladwin | Dentist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dentist
- Gladwin, MI
- NPI 1104947878
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1750483376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 WEST CEDAR AVE",
"city": "GLADWIN",
"state": "MI",
"postal_code": "48624",
"telephone_number": "989-426-6341",
"fax_number": "989-426-6411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 WEST CEDAR AVE",
"city": "GLADWIN",
"state": "MI",
"postal_code": "48624",
"telephone_number": "989-426-6341",
"fax_number": "989-426-6411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUSKE",
"first_name": "RONALD",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "01S374",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2926515",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gladwin, MI
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.