Individual
DR. PHIL NOBLE RUCKMAN III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
6405 GEORGETOWN NORTH BLVD, FORT WAYNE, IN 46815-7007
(260) 485-0583
Mailing address
10708 TRADE WIND CT, FORT WAYNE, IN 46825-2662
(260) 750-7825
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12011439A
IN
Other
Enumeration date
05/24/2010
Last updated
05/24/2010
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