Phil Noble Ruckman III, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12011439A Issued in IN

Practice address

6405 Georgetown North Blvd
Fort Wayne, IN 46815-7007

Phone

(260) 485-0583

NPI assigned

May 24, 2010

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)

Enrolled

State licenses

Practice roles

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.

• Bruick Dentistry PC

  • General Practice Dentistry
  • Fort Wayne, IN
  • NPI 1740448232
  NPD (past)
• Georgetown North Dental Care LLC

  • Dental Clinic/Center
  • Fort Wayne, IN
  • NPI 1255849667
  NPD (past)
• Ruckman Oral Surgery & Implant Center

  • Oral and Maxillofacial Surgery (Dentist)
  • Fort Wayne, IN
  • NPI 1093250151
  NPD (past)

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

{
    "created_epoch": "1274659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274659200000",
    "number": "1861711244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10708 TRADE WIND CT",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468252662",
            "telephone_number": "260-750-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6405 GEORGETOWN NORTH BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468157007",
            "telephone_number": "260-485-0583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUCKMAN",
        "first_name": "PHIL",
        "middle_name": "NOBLE",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-05-24",
        "last_updated": "2010-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12011439A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ruckel Chiropractic PC
• Charles E Ruckel, DC
• Ruckel, Inc.
• James S Ruckel, DC
• Ruckman Oral Surgery & Implant Center
• Melea Ann Rudig
• Michael Rudoff, D.O.
• James Raymond Rudolph, M.D.
• Rhys Rudolph, M.D.
• Thomas M Ruediger, PT

• General Practice Dentistry in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2010; 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.