Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 0160002095 | VT |
NPI | 1093814097 |
---|---|
Provider Name | Dr. Thomas J Ruescher |
First Address | South Burlington, VT 05403-7204 |
Second Address | South Burlington, VT 05403-7204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1007402 | (05) | VT |