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General NPI Number Information
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NPI Number | 1205242187
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Entity Type | Individual
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Provider Name | RUTH OWUSU-BOAHENE DDS
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Gender | Female
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Dates
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Enumeration Date | 07/11/2014
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Last Update Date | 02/05/2018
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Provider Practice Location Address
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Address Line | 10000 OLD COLUMBIA RD STE H
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City | COLUMBIA
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State | MD
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Zip | 21046-2275
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Country | US
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Telephone | 443-542-9519
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Fax | 443-288-4402
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Provider Business Mailing Address
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Address Line | 10000 OLD COLUMBIA RD STE H
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City | COLUMBIA
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State | MD
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Zip | 21046-2275
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Country | US
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Telephone | 443-542-9519
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Fax | 443-288-4402
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 15603
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License Number State | MD
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