Active NPI
Ruby J Lake
- Dentist
- Frederiksted, VI
National Provider Identifier
1487907192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 708
- Practice address
- 16 Strand Street
Frederiksted, VI 00840 - Phone
- (340) 772-1616
- Fax
- (340) 772-1616
- NPI assigned
- Oct 18, 2012
- Last updated
- Oct 18, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 708 | VI | Primary |
Addresses
Primary practice location
16 Strand Street
Frederiksted, VI 00840
Mailing address
414 Strand Street
Frederiksted, VI 00840
Phone (340) 772-1616
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
| License | State | Type | Specialty |
|---|---|---|---|
| 708 | VI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350518400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350518400000",
"number": "1487907192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "414 STRAND STREET",
"city": "FREDERIKSTED",
"state": "VI",
"postal_code": "00840",
"telephone_number": "340-772-1616",
"fax_number": "340-772-1616"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16 STRAND STREET",
"city": "FREDERIKSTED",
"state": "VI",
"postal_code": "00840",
"telephone_number": "340-772-1616",
"fax_number": "340-772-1616"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAKE",
"first_name": "RUBY",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-18",
"last_updated": "2012-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VI",
"license": "708",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Frederiksted, VI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 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.