Larry David Wruck, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1632G Issued in WI

Practice address

15855 W National Ave
Suite 104
New Berlin, WI 53151-5159

Phone

(262) 782-4220

Fax

(262) 782-5471

NPI assigned

Jan 16, 2007

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1760533459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15855 W NATIONAL AVE",
            "address_2": "SUITE 104",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531515159",
            "telephone_number": "262-782-4220",
            "fax_number": "262-782-5471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15855 W NATIONAL AVE",
            "address_2": "SUITE 104",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531515159",
            "telephone_number": "262-782-4220",
            "fax_number": "262-782-5471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WRUCK",
        "first_name": "LARRY",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1632G",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Kae Wisinski, P.T.
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• Kim Marie Wolf, NURSE PRACTITIONER
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• Patti Marie Young, M.D.

• General Practice Dentistry in New Berlin, WI
• Providers in New Berlin, WI by specialty
• General Practice Dentistry in Wisconsin

• 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.

Verify at the official NPI Registry.