Provider Demographics
NPI:1134322423
Name:RUIZ-ADIB, DENNISSE (MD)
Entity Type:Individual
Prefix:
First Name:DENNISSE
Middle Name:
Last Name:RUIZ-ADIB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 COIT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-3731
Mailing Address - Country:US
Mailing Address - Phone:972-985-0123
Mailing Address - Fax:
Practice Address - Street 1:4001 W 15TH ST STE 480
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5853
Practice Address - Country:US
Practice Address - Phone:972-985-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXM7582207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM7582OtherTX LIC