Provider Demographics
NPI:1598102790
Name:RUIZ, GERALDINE ENRIQUETA (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALDINE
Middle Name:ENRIQUETA
Last Name:RUIZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 E LINCOLN AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-1962
Mailing Address - Country:US
Mailing Address - Phone:714-417-5866
Mailing Address - Fax:
Practice Address - Street 1:1122 E LINCOLN AVE STE 212
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-1962
Practice Address - Country:US
Practice Address - Phone:714-497-2747
Practice Address - Fax:657-999-0599
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62249122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist