Provider Demographics
NPI:1871930636
Name:RYAN J. RUPERT D.M.D. L.L.C.
Entity type:Organization
Organization Name:RYAN J. RUPERT D.M.D. L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:RUPERT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-736-0794
Mailing Address - Street 1:66 FOREST GROVE RD
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-3451
Mailing Address - Country:US
Mailing Address - Phone:412-859-3833
Mailing Address - Fax:
Practice Address - Street 1:66 FOREST GROVE RD
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-3451
Practice Address - Country:US
Practice Address - Phone:412-859-3833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037526261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental