Provider Demographics
NPI:1225191679
Name:MASSO, RUTH L (DENTIST)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:L
Last Name:MASSO
Suffix:
Gender:F
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 STONELEIGH AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3931
Mailing Address - Country:US
Mailing Address - Phone:845-225-8802
Mailing Address - Fax:845-225-8802
Practice Address - Street 1:686 STONELEIGH AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3931
Practice Address - Country:US
Practice Address - Phone:845-225-8802
Practice Address - Fax:845-225-8802
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0480641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01917197Medicaid