Healthcare Provider Details

I. General information

NPI: 1518007202
Provider Name (Legal Business Name): RUBY KING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N CLEVELAND AVE SUITE 1
WINSTON SALEM NC
27101-4366
US

IV. Provider business mailing address

390 WILL SNIDER RD
LINWOOD NC
27299-9057
US

V. Phone/Fax

Practice location:
  • Phone: 336-631-2330
  • Fax: 336-631-2340
Mailing address:
  • Phone: 336-752-2485
  • Fax: 336-631-2340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3468
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: