Provider Demographics
NPI:1902423130
Name:RUAN, COZY (DDS)
Entity Type:Individual
Prefix:DR
First Name:COZY
Middle Name:
Last Name:RUAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 W YORK ST UNIT 3606
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1567
Mailing Address - Country:US
Mailing Address - Phone:904-562-8894
Mailing Address - Fax:
Practice Address - Street 1:249 HANBURY RD E STE 110
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-6623
Practice Address - Country:US
Practice Address - Phone:757-410-5948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014169731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice