Provider Demographics
NPI:1760689889
Name:RUTH, PAULA ELIZABETH (RDH)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:ELIZABETH
Last Name:RUTH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E TIMOTHY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STRAFFORD
Mailing Address - State:MO
Mailing Address - Zip Code:65757-7846
Mailing Address - Country:US
Mailing Address - Phone:417-859-4727
Mailing Address - Fax:
Practice Address - Street 1:601 N 21ST ST # 603
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-9184
Practice Address - Country:US
Practice Address - Phone:417-582-5439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007015403124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2007015403OtherDENTAL HYGIENE LICENSE