=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942484415
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RUTH GOMES DMD, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2007
-----------------------------------------------------
Last Update Date | 08/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 141 N MERAMEC AVE
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63105-3393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-727-3300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 618 N NEW BALLAS RD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63141-6763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-650-2390
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | ARMANDO GOMES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-650-2390
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------