Provider Demographics
NPI:1871356253
Name:BURKE, RUTH (RDH)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:
Other - Last Name:TROTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6016 DOTSON LN
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-9734
Mailing Address - Country:US
Mailing Address - Phone:605-891-1782
Mailing Address - Fax:
Practice Address - Street 1:1300 STEDMAN ST
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-6661
Practice Address - Country:US
Practice Address - Phone:907-228-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1216124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist