Provider Demographics
NPI:1578720280
Name:NORMA S. RUANO D.D.S. PA
Entity Type:Organization
Organization Name:NORMA S. RUANO D.D.S. PA
Other - Org Name:SONRISAS DE NINOS PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:S
Authorized Official - Last Name:RUANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-432-1886
Mailing Address - Street 1:910 BANDERA RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-4920
Mailing Address - Country:US
Mailing Address - Phone:210-432-1886
Mailing Address - Fax:
Practice Address - Street 1:910 BANDERA RD
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-4920
Practice Address - Country:US
Practice Address - Phone:210-432-1886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX149871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120908204Medicaid