Provider Demographics
NPI:1598545121
Name:GONZALEZ RUIZ, MANUEL ARTURO JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:ARTURO
Last Name:GONZALEZ RUIZ
Suffix:JR
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 1:3170 CLAIREMONT DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6411
Mailing Address - Country:US
Mailing Address - Phone:619-907-7918
Mailing Address - Fax:
Practice Address - Street 1:3170 CLAIREMONT DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6411
Practice Address - Country:US
Practice Address - Phone:619-907-7918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1095381223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA109538Medicaid