Individual
RUSLAN RUSANOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
350 PINE ST, RAPID CITY, SD 57701-1669
(605) 721-8939
Mailing address
350 PINE ST, RAPID CITY, SD 57701-1669
(605) 721-8939
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D1268
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122300000X
—
SD
Enumeration date
04/07/2020
Last updated
05/17/2021
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