Provider Demographics
NPI:1144113879
Name:GAO, RUOYUN
Entity type:Individual
Prefix:DR
First Name:RUOYUN
Middle Name:
Last Name:GAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7815 BLUE STREAM DR
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-8168
Mailing Address - Country:US
Mailing Address - Phone:276-252-6668
Mailing Address - Fax:
Practice Address - Street 1:352 THOMPSON CREEK MALL
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2500
Practice Address - Country:US
Practice Address - Phone:410-934-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18699122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist