Provider Demographics
NPI:1548258056
Name:EDMONDS, RUTH ROSS (DDS, MDS)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:ROSS
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:DDS, MDS
Other - Prefix:DR
Other - First Name:RUTH
Other - Middle Name:ELAINE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1704 CHARLOTTE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203
Mailing Address - Country:US
Mailing Address - Phone:615-321-3663
Mailing Address - Fax:615-321-3664
Practice Address - Street 1:1704 CHARLOTTE AVE STE 100
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203
Practice Address - Country:US
Practice Address - Phone:615-321-3663
Practice Address - Fax:615-321-3664
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000076241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3226814Medicaid