Provider Demographics
NPI:1316019896
Name:RUIZ, KIMBERLY RIGGS (DDS)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:RIGGS
Last Name:RUIZ
Suffix:
Gender:F
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:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464
Mailing Address - Country:US
Mailing Address - Phone:931-762-5525
Mailing Address - Fax:931-762-5546
Practice Address - Street 1:234 E GAINES ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464
Practice Address - Country:US
Practice Address - Phone:931-762-5525
Practice Address - Fax:931-762-5546
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN83731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440293Medicaid
TN1519982Medicaid