Provider Demographics
NPI:1063594588
Name:RUFFIN, DENISE R (DDS)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:R
Last Name:RUFFIN
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 1:2701 DAVIS STREET
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-5708
Mailing Address - Country:US
Mailing Address - Phone:601-693-0118
Mailing Address - Fax:601-553-8175
Practice Address - Street 1:2701 DAVIS STREET
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-5708
Practice Address - Country:US
Practice Address - Phone:601-693-0118
Practice Address - Fax:844-778-8922
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3208-01122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000660392Medicaid