Provider Demographics
NPI:1083745921
Name:RUIZ-PRIMAVERA, MARISOL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARISOL
Middle Name:
Last Name:RUIZ-PRIMAVERA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5940 NW 81ST TER
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-5013
Mailing Address - Country:US
Mailing Address - Phone:561-395-0550
Mailing Address - Fax:
Practice Address - Street 1:7301 W PALMETTO PARK RD
Practice Address - Street 2:SUITE 205 C
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3458
Practice Address - Country:US
Practice Address - Phone:561-395-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00125441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice