Provider Demographics
NPI:1164803417
Name:EDSON MARTINEZ-RUIZ, DDS, PA
Entity Type:Organization
Organization Name:EDSON MARTINEZ-RUIZ, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-775-2443
Mailing Address - Street 1:1121 AVENUE E
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-3915
Mailing Address - Country:US
Mailing Address - Phone:830-775-2443
Mailing Address - Fax:830-775-2214
Practice Address - Street 1:1121 AVENUE E
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-3915
Practice Address - Country:US
Practice Address - Phone:830-775-2443
Practice Address - Fax:830-775-2214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty