PHIL N RUCKMAN III Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000925

License Status

NOT RENEWED

Business

First Name

PHIL

Middle

Last Name

RUCKMAN III

Business Name

PHIL N RUCKMAN III

Original Issue Date

07/29/2015

Effective Date

10/21/2021

Expiration Date

09/30/2024

City

FORT WAYNE

State

Zip

46825

Specialty/Qualifier

DEEP SEDATION AND GENERAL ANESTHESIA

Ever Disciplined

LastModifiedDate

02/04/2025