Provider Demographics
NPI:1245084979
Name:RUBY-SCHULTZ, JASIAH TOOK (CDA)
Entity type:Individual
Prefix:
First Name:JASIAH
Middle Name:TOOK
Last Name:RUBY-SCHULTZ
Suffix:
Gender:M
Credentials:CDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 EVERGREEN PARK CT SW APT 23
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5859
Mailing Address - Country:US
Mailing Address - Phone:206-434-0877
Mailing Address - Fax:
Practice Address - Street 1:8050 FREEDOM LN NE STE C
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-4761
Practice Address - Country:US
Practice Address - Phone:360-464-4597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA264321126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant