Provider Demographics
NPI:1215099643
Name:RUOHO, JENNY REBECCA (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNY
Middle Name:REBECCA
Last Name:RUOHO
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 1:1475 WHITE OAK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2945
Mailing Address - Country:US
Mailing Address - Phone:952-351-8282
Mailing Address - Fax:952-466-2777
Practice Address - Street 1:1475 WHITE OAK DR
Practice Address - Street 2:200
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-4571
Practice Address - Country:US
Practice Address - Phone:952-351-8282
Practice Address - Fax:952-491-2111
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2008-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND117441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice