Healthcare Provider Details

I. General information

NPI: 1164600516
Provider Name (Legal Business Name): RUTH FRANCINE CAUTHEN D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 COLONIAL AVE STE 12
NORFOLK VA
23517-1919
US

IV. Provider business mailing address

PO BOX 447
NORFOLK VA
23501-0447
US

V. Phone/Fax

Practice location:
  • Phone: 757-626-0633
  • Fax: 757-626-0003
Mailing address:
  • Phone: 757-626-0633
  • Fax: 757-626-0003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7333
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: