Provider Demographics
NPI:1023236940
Name:RUO, HIKO (DMD)
Entity type:Individual
Prefix:DR
First Name:HIKO
Middle Name:
Last Name:RUO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MONTGOMERY DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-6630
Mailing Address - Country:US
Mailing Address - Phone:707-528-3412
Mailing Address - Fax:707-528-1058
Practice Address - Street 1:95 MONTGOMERY DR
Practice Address - Street 2:SUITE 212
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-6630
Practice Address - Country:US
Practice Address - Phone:707-528-3412
Practice Address - Fax:707-528-1058
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA545741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice