Provider Demographics
NPI:1689855603
Name:FREMONT, RUTH (DDS)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:
Last Name:FREMONT
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 1:5828B MARKET ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-3114
Mailing Address - Country:US
Mailing Address - Phone:215-747-6901
Mailing Address - Fax:215-747-6907
Practice Address - Street 1:5828B MARKET ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19139-3114
Practice Address - Country:US
Practice Address - Phone:215-747-6901
Practice Address - Fax:215-747-6907
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021445L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001950650Medicaid