Provider Demographics
NPI:1356449599
Name:ABRAHAM, RUTH A (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:A
Last Name:ABRAHAM
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 1:1454 MORNINGSIDE CT SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-3351
Mailing Address - Country:US
Mailing Address - Phone:503-588-8857
Mailing Address - Fax:503-588-1198
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD69111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice