Provider Demographics
NPI:1376519595
Name:PEREIRA-RUIZ, PEDRO LUIS (DMD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:LUIS
Last Name:PEREIRA-RUIZ
Suffix:
Gender:M
Credentials:DMD
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 1902
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-1902
Mailing Address - Country:US
Mailing Address - Phone:787-565-8089
Mailing Address - Fax:
Practice Address - Street 1:BH12 CALLE 110
Practice Address - Street 2:VALLE ARRIBA HEIGHTS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-3309
Practice Address - Country:US
Practice Address - Phone:787-768-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR043157Medicare UPIN
PRP368Medicare UPIN
PR42088Medicare UPIN
PR7250101Medicare UPIN
PR1729400Medicare UPIN
PR206801Medicare UPIN