Individual
MR. KENNETH BRIAN RUSANOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2 CALLE MEDICO, STE 2, SANTA FE, NM 87505
(505) 988-2611
(505) 820-0397
Mailing address
2 CALLE MEDICO, STE 2, SANTA FE, NM 87505
(505) 988-2611
(505) 820-0397
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
DD1585
NM
Other
Enumeration date
01/18/2007
Last updated
07/08/2007
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