NPIMap

Individual provider Active NPI

Andrea K Ruby, D.M.D.

  • Dentist
  • St Louis Park, MN
National Provider Identifier
1013202084
Registry record updated Jun 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D12985 Issued in MN
Practice address
3345 Dakota Ave S
St Louis Park, MN 55416-2039
Phone
(952) 929-9450
NPI assigned
Jun 17, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D12985 MN Primary

Addresses

Primary practice location

3345 Dakota Ave S
St Louis Park, MN 55416-2039

Mailing address

3345 Dakota Ave S
St Louis Park, MN 55416-2039
Phone (952) 929-9450

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
D12985MNMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Jeffrey H. Miller, DDS. Past Accepting new patients
Dr. Andrea K Ruby DMD PLLC Past Accepting new patients
Modern Dental Professionals, Minnesota PC Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339372800000",
    "number": "1013202084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3345 DAKOTA AVE S",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554162039",
            "telephone_number": "952-929-9450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3345 DAKOTA AVE S",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554162039",
            "telephone_number": "952-929-9450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUBY",
        "first_name": "ANDREA",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-17",
        "last_updated": "2012-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D12985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.