Individual
RUSLAN FOMENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2815 GARFIELD RD N, TRAVERSE CITY, MI 49686-5005
(231) 947-4380
Mailing address
2815 GARFIELD RD N, TRAVERSE CITY, MI 49686-5005
(231) 947-4380
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901602281
MI
Other
Enumeration date
06/12/2024
Last updated
06/12/2024
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