Provider Demographics
NPI:1114229739
Name:RUIZ DENTAL PLLC
Entity Type:Organization
Organization Name:RUIZ DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-851-2828
Mailing Address - Street 1:6262 WEBER RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-4006
Mailing Address - Country:US
Mailing Address - Phone:361-851-2828
Mailing Address - Fax:
Practice Address - Street 1:6262 WEBER RD
Practice Address - Street 2:SUITE 120
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-4006
Practice Address - Country:US
Practice Address - Phone:361-851-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX178651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126682707Medicaid