Provider Demographics
NPI:1568957157
Name:RUTH, CARMEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:
Last Name:RUTH
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 1:14710 TN-194
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38060
Mailing Address - Country:US
Mailing Address - Phone:901-808-3035
Mailing Address - Fax:
Practice Address - Street 1:14710 TN-194
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:TN
Practice Address - Zip Code:38060
Practice Address - Country:US
Practice Address - Phone:901-808-3035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10846122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist