Provider Demographics
NPI:1598181042
Name:DELGADO-RUIZ, RAFAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:DELGADO-RUIZ
Suffix:
Gender:M
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:SCHOOL OF DENTAL MEDICINE
Mailing Address - Street 2:1103 WESTCHESTER HALL
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8712
Mailing Address - Country:US
Mailing Address - Phone:631-632-6913
Mailing Address - Fax:
Practice Address - Street 1:SCHOOL OF DENTAL MEDICINE
Practice Address - Street 2:1103 WESTCHESTER HALL
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8712
Practice Address - Country:US
Practice Address - Phone:631-632-6913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000048-11223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics