Provider Demographics
NPI:1902864598
Name:RUPP, WILLIAM III (DDS)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:RUPP
Suffix:III
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 1:7403 N 41ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:MI
Mailing Address - Zip Code:49012
Mailing Address - Country:US
Mailing Address - Phone:269-731-5814
Mailing Address - Fax:
Practice Address - Street 1:3299 GULL RD
Practice Address - Street 2:KALAMAZOO COUNTY DENTAL CLINIC
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048
Practice Address - Country:US
Practice Address - Phone:269-373-5200
Practice Address - Fax:269-373-5363
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI09275122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist