Provider Demographics
NPI:1770665127
Name:RUE, PAUL R (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:RUE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 JOHNNY MERCER BLVD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-2150
Mailing Address - Country:US
Mailing Address - Phone:912-235-3610
Mailing Address - Fax:912-235-3611
Practice Address - Street 1:318 JOHNNY MERCER BLVD
Practice Address - Street 2:SUITE 12
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-2150
Practice Address - Country:US
Practice Address - Phone:912-235-3610
Practice Address - Fax:912-235-3611
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA79241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice