Provider Demographics
NPI:1366565145
Name:RUHLIG, GARY GORDON (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:GORDON
Last Name:RUHLIG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 S MAIN ST
Mailing Address - Street 2:STE B
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341
Mailing Address - Country:US
Mailing Address - Phone:616-866-2166
Mailing Address - Fax:616-866-9478
Practice Address - Street 1:65 S MAIN ST
Practice Address - Street 2:STE B
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341
Practice Address - Country:US
Practice Address - Phone:616-866-2166
Practice Address - Fax:616-866-9478
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI015354122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist