Provider Demographics
NPI:1326133265
Name:MIRZA, RUBY F (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUBY
Middle Name:F
Last Name:MIRZA
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 1:11042 NICHOLAS LN
Mailing Address - Street 2:SUITE B101
Mailing Address - City:OCEAN PINES
Mailing Address - State:MD
Mailing Address - Zip Code:21811-3299
Mailing Address - Country:US
Mailing Address - Phone:410-208-9009
Mailing Address - Fax:410-208-9019
Practice Address - Street 1:11042 NICHOLAS LN
Practice Address - Street 2:SUITE B101
Practice Address - City:OCEAN PINES
Practice Address - State:MD
Practice Address - Zip Code:21811-3299
Practice Address - Country:US
Practice Address - Phone:410-208-9009
Practice Address - Fax:410-208-9019
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD122321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice