Healthcare Provider Details

I. General information

NPI: 1386230100
Provider Name (Legal Business Name): RUBY DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MILLTOWN ROAD ATTN: TJ HAMMER
WILMINGTON DE
19808
US

IV. Provider business mailing address

25 MILLTOWN RD
WILMINGTON DE
19808-3107
US

V. Phone/Fax

Practice location:
  • Phone: 302-299-5617
  • Fax:
Mailing address:
  • Phone: 302-299-5617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RYAN P ROBINSON
Title or Position: OWNER
Credential: DDS
Phone: 302-299-5617