Provider Demographics
NPI:1467638866
Name:BLACK & RUIZ DENTAL CENTRE, INC.
Entity Type:Organization
Organization Name:BLACK & RUIZ DENTAL CENTRE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:NANESE
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-351-2762
Mailing Address - Street 1:1600 S COULTER ST
Mailing Address - Street 2:BLDG B SUITE 208
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1710
Mailing Address - Country:US
Mailing Address - Phone:806-351-2762
Mailing Address - Fax:806-351-2763
Practice Address - Street 1:1600 S COULTER ST
Practice Address - Street 2:BLDG B SUITE 208
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1710
Practice Address - Country:US
Practice Address - Phone:806-351-2762
Practice Address - Fax:806-351-2763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17910,20035,138611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG60131-01OtherCHIPS