Provider Demographics
NPI:1700069358
Name:BISSON, RUBY ANN ESTANIEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:RUBY ANN
Middle Name:ESTANIEL
Last Name:BISSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10670 CRESTWOOD DR STE B
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-4408
Mailing Address - Country:US
Mailing Address - Phone:703-361-0555
Mailing Address - Fax:703-361-6255
Practice Address - Street 1:10670 CRESTWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-4408
Practice Address - Country:US
Practice Address - Phone:703-361-0555
Practice Address - Fax:703-361-6255
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010089551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice