Provider Demographics
NPI:1164600516
Name:CAUTHEN, RUTH FRANCINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:FRANCINE
Last Name:CAUTHEN
Suffix:
Gender:F
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:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0447
Mailing Address - Country:US
Mailing Address - Phone:757-626-0633
Mailing Address - Fax:757-626-0003
Practice Address - Street 1:2200 COLONIAL AVE STE 12
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1919
Practice Address - Country:US
Practice Address - Phone:757-626-0633
Practice Address - Fax:757-626-0003
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA73331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7820126Medicaid
VA279570OtherBCBS