Provider Demographics
NPI:1003126343
Name:RAMIREZ, JOSE RUBEN SR (DDS)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:RUBEN
Last Name:RAMIREZ
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:RUBEN
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:524 N PALM AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3218
Mailing Address - Country:US
Mailing Address - Phone:909-467-2039
Mailing Address - Fax:909-467-2052
Practice Address - Street 1:524 N PALM AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3218
Practice Address - Country:US
Practice Address - Phone:909-467-2039
Practice Address - Fax:909-467-2052
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA261279944OtherDENTAL