Provider Demographics
NPI:1164606778
Name:RUTH A ABRAHAM D.D.S. P.C.
Entity Type:Organization
Organization Name:RUTH A ABRAHAM D.D.S. P.C.
Other - Org Name:NORTH RIVER ROAD DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-390-1100
Mailing Address - Street 1:3857 RIVER RD N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4803
Mailing Address - Country:US
Mailing Address - Phone:503-390-1100
Mailing Address - Fax:503-390-4455
Practice Address - Street 1:3857 RIVER RD N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4803
Practice Address - Country:US
Practice Address - Phone:503-390-1100
Practice Address - Fax:503-390-4455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental