Provider Demographics
NPI:1477904670
Name:RUIZ, MOLLY HAWKINS (DMD)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:HAWKINS
Last Name:RUIZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3270 WALTON RIVERWOOD LN SE
Mailing Address - Street 2:APARTMENT 3019
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3561
Mailing Address - Country:US
Mailing Address - Phone:678-371-5181
Mailing Address - Fax:
Practice Address - Street 1:1015 DONALD LEE HOLLOWELL PKWY NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-6653
Practice Address - Country:US
Practice Address - Phone:404-523-6571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist