Provider Demographics
NPI:1033241260
Name:RUTH B GARZON DENTAL PRACTICE INC
Entity Type:Organization
Organization Name:RUTH B GARZON DENTAL PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:B
Authorized Official - Last Name:GARZON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-773-2131
Mailing Address - Street 1:509 FIVE CITIES DR
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449
Mailing Address - Country:US
Mailing Address - Phone:805-773-2131
Mailing Address - Fax:805-773-8656
Practice Address - Street 1:509 FIVE CITIES DR
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449
Practice Address - Country:US
Practice Address - Phone:805-773-2131
Practice Address - Fax:805-773-8656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50913261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental