MR. KENNETH BRIAN RUSANOWSKI (NPI# 1174675185) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174675185 |
| Entity Type | Individual |
| Full Name | MR. KENNETH BRIAN RUSANOWSKI |
| Credential | DDS |
| Practice Address |
2 Calle Medico Ste 2 Santa Fe NM 87505 |
| Practice Telephone | 5059882611 |
| Practice Fax Number | 5058200397 |
| Mailing Telephone | 5059882611 |
| Mailing Fax Number | 5058200397 |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
DD1585 | NM | Dental Providers |
| Street Address |
2 CALLE MEDICO STE 2 |
| City | SANTA FE |
| State | NM |
| Zip Code | 87505 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386606101 | Erick F Carlgren | Dentist | 2 Calle Medico, Suite 3, Santa Fe, NM 87505-4785 | 2006-04-05 |
| 1720262298 | Llani M Mraz | Counselor | 2 Calle Medico, Suite 5a, Santa Fe, NM 87505-4785 | 2007-12-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154939031 | Enchanted Sky Hospice,llc | Hospice Care, Community Based | 1692b Hospital Drive, Vigil Office Building, Suite 201a, Santa Fe, NM 87505 | 2020-07-16 |
| 1700409968 | Caa Consulting, LLC | Clinic/Center | 1448 S St. Francis Drive, Santa Fe, NM 87505 | 2020-05-22 |
| 1104447093 | Dana Marie Tsyconyea Simmons | Counselor | 1640 Calle Medico, Suite E, Santa Fe, NM 87505 | 2020-05-01 |
| 1114574217 | Kumara Hampton Therapy, LLC | Counselor | 11 Calle Medico Suite 4, Santa Fe, NM 87505 | 2019-08-22 |
| 1245886977 | Caroline Ward | Technician | 513 Velarde St 513 Velarde St, Santa Fe, NM 87505 | 2019-08-19 |
| 1205490752 | Alyson Yacono | Physical Therapist | 104 Old Las Vegas Highway, Santa Fe, NM 87505 | 2019-04-30 |
| 1366919649 | Allyson Matthews | Speech-Language Pathologist | Santa Fe Public Schools Special Education Department, 1300 Camino Sierra Vista, Santa Fe, NM 87505 | 2018-10-25 |
| 1093280281 | Diamond Care Santa Fe LLC | Skilled Nursing Facility | 635 Harkle Road, Santa Fe, NM 87505 | 2018-10-04 |
| 1972087054 | Changing Woman Initiative | Advanced Practice Midwife | 460 Saint Michaels Drive, Suite 804, Santa Fe, NM 87505 | 2018-09-24 |
| 1154812782 | Heart Wing, LLC | Social Worker | 2724 Alamosa Drive, Santa Fe, NM 87505 | 2018-05-18 |
| Find all providers in zip 87505 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326206814 | John Jeffrey Melton | Dentist | 141 Paseo De Peralta, Santa Fe, NM 87501-2914 | 2008-05-30 |
| 1205026796 | Bill Dean Parker | Dentist | 318 Grant Ave, Santa Fe, NM 87501-1933 | 2007-07-31 |
| 1043371842 | Northern New Mexico Periodontal Assoc. | Dentist | 318 Grant Ave, Santa Fe, NM 87501-1933 | 2006-12-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972118685 | Southwest Periodontal and Implants | Dentist | 3045 E University Ave Ste A, Las Cruces, NM 88011-9147 | 2020-09-10 |
| 1316455017 | Pino Periodontics, LLC | Dentist | 7007 Wyoming Blvd Ne Ste D1, Albuquerque, NM 87109-3981 | 2018-01-16 |
| 1407140361 | Kevin Charles Harrison | Dentist | 10151 Montgomery Blvd Ne Ste C, Albuquerque, NM 87111-3670 | 2011-06-07 |
| 1023332350 | Chun-xiao Sun | Dentist | 8501 Candelaria Rd Ne Ste D3, Albuquerque, NM 87112-1032 | 2010-03-15 |
| 1124287206 | Redemption | Dentist | 4550 Eubank N.e., Suite 207, Albuquerque, NM 87111-2565 | 2008-06-04 |
| 1417122102 | James Bradley Aday | Dentist | 2701 Missouri Ave Ste E, Las Cruces, NM 88011-5091 | 2008-04-24 |
| 1871681700 | Albuquerque Implant & Periodontal Consultants. LLC | Dentist | 10425 Montgomery Pkwy Ne, Albuquerque, NM 87111-3864 | 2006-10-10 |
| 1306931035 | Henry D Espinosa | Dentist | 10409 Montgomery Pkwy Ne #203, Albuquerque, NM 87111 | 2006-10-04 |
| 1851308290 | Dianna R Montoya | Dentist | 1105 Golf Course Rd Se, Bld A, Rio Rancho, NM 87124-4733 | 2006-08-01 |
| 1356366975 | Mark A. Ferrari | Dentist | 10250 Cottonwood Park Nw Ste B, Albuquerque, NM 87114-7019 | 2006-07-13 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.