Provider Demographics
NPI:1225147929
Name:RUIZ, ROBERT D (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:RUIZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:915-593-6661
Mailing Address - Fax:361-851-2830
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:361-851-2830
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17865122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN009866701Medicaid