Provider Demographics
NPI:1114340114
Name:REDD, RUTH ELLEN (RDHAP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ELLEN
Last Name:REDD
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5313 CARNEIA CT
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-5009
Mailing Address - Country:US
Mailing Address - Phone:916-612-6770
Mailing Address - Fax:
Practice Address - Street 1:5313 CARNEIA CT
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-5009
Practice Address - Country:US
Practice Address - Phone:916-612-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA503124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist