Provider Demographics
NPI:1033288063
Name:RUIZ, MILTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:
Last Name:RUIZ
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 1:1541 N PALM AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3229
Mailing Address - Country:US
Mailing Address - Phone:954-432-6133
Mailing Address - Fax:954-432-8989
Practice Address - Street 1:1541 N PALM AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3229
Practice Address - Country:US
Practice Address - Phone:954-432-6133
Practice Address - Fax:954-432-8989
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13346122300000X
FL13346332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL071451801Medicaid