Healthcare Provider Details

I. General information

NPI: 1447608195
Provider Name (Legal Business Name): RUBY MORRIS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 COCHRANE CIR BLDG 7495
FORT CARSON CO
80913-4603
US

IV. Provider business mailing address

1667 COCHRANE CIR BLDG 7495
FORT CARSON CO
80913-4603
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-5537
  • Fax:
Mailing address:
  • Phone: 719-526-5537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number7725
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: