Provider Demographics
NPI:1568957157
Name:RUTH, CARMEN (DDS)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:
Last Name:RUTH
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 1:3500 OLD WASHINGTON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3224
Mailing Address - Country:US
Mailing Address - Phone:301-645-4434
Mailing Address - Fax:
Practice Address - Street 1:3500 OLD WASHINGTON RD STE 300
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3224
Practice Address - Country:US
Practice Address - Phone:301-645-4434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10846122300000X
MD17294122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist