Provider Demographics
NPI:1457675480
Name:HUCKABY, RUTH V (RDHAP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:V
Last Name:HUCKABY
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 SWAN ST
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1433
Mailing Address - Country:US
Mailing Address - Phone:650-577-9898
Mailing Address - Fax:
Practice Address - Street 1:929 SWAN ST
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-1433
Practice Address - Country:US
Practice Address - Phone:650-577-9898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA279124Q00000X
CA20612124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist