Healthcare Provider Details

I. General information

NPI: 1881085678
Provider Name (Legal Business Name): CHRISTOPHER RUTH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2015
Last Update Date: 02/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7780 BRIER CREEK PKWY #100
RALEIGH NC
27617-7849
US

IV. Provider business mailing address

201 PARK AT NORTH HILLS ST APT 356
RALEIGH NC
27609-5776
US

V. Phone/Fax

Practice location:
  • Phone: 919-957-9400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9938
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: