Provider Demographics
NPI:1407901416
Name:RUVALCABA, RAMON JR (DDS)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:
Last Name:RUVALCABA
Suffix:JR
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 1:2517 S BUCKNER BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-8501
Mailing Address - Country:US
Mailing Address - Phone:214-275-0172
Mailing Address - Fax:214-275-8523
Practice Address - Street 1:2517 S BUCKNER BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-8501
Practice Address - Country:US
Practice Address - Phone:214-275-0172
Practice Address - Fax:214-275-8523
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX13685122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1942300181OtherGROUP NPI