Provider Demographics
NPI:1487043659
Name:ENDODONTICS & PERIODONTICS ASSOC.
Entity Type:Organization
Organization Name:ENDODONTICS & PERIODONTICS ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-960-9080
Mailing Address - Street 1:4244 W LINEBAUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-5241
Mailing Address - Country:US
Mailing Address - Phone:813-960-9080
Mailing Address - Fax:813-960-1090
Practice Address - Street 1:4244 W LINEBAUGH AVE
Practice Address - Street 2:SAME
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-5241
Practice Address - Country:US
Practice Address - Phone:813-960-9080
Practice Address - Fax:813-960-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12062122300000X
FL13928122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty