Provider Demographics
NPI:1073636098
Name:RUIZ, MARCO A
Entity Type:Individual
Prefix:DR
First Name:MARCO
Middle Name:A
Last Name:RUIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 N ED CAREY DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8202
Mailing Address - Country:US
Mailing Address - Phone:956-423-0191
Mailing Address - Fax:956-423-7907
Practice Address - Street 1:1724 N ED CAREY DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8202
Practice Address - Country:US
Practice Address - Phone:956-423-0191
Practice Address - Fax:956-423-7907
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22512122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist