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General NPI Number Information
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NPI Number | 1578085361
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Entity Type | Organization
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Legal Business Name | DR. ANDREA K RUBY DMD PLLC
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 07/12/2017
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Provider Practice Location Address
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Address Line | 2934 TEXAS AVE S
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City | ST LOUIS PARK
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State | MN
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Zip | 55426-3086
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Country | US
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Telephone | 952-935-7707
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Fax | 952-935-7708
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Provider Business Mailing Address
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Address Line | 22 WESTERN TERRACE
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City | GOLDEN VALLEY
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State | MN
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Zip | 55426
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Country | US
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Telephone | 617-763-4033
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ANDREA K RUBY
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Credential | DMD
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Telephone | 617-763-4033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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