Healthcare Provider Details

I. General information

NPI: 1396435970
Provider Name (Legal Business Name): RUIYANG QIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 E 18TH ST
ROLLA MO
65401-3398
US

IV. Provider business mailing address

2427 LOWNDES PT
MISSOURI CITY TX
77459-1376
US

V. Phone/Fax

Practice location:
  • Phone: 573-426-4455
  • Fax:
Mailing address:
  • Phone: 832-858-3782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2026026599
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: