Provider Demographics
NPI:1629329966
Name:DENNISSE RUIZ-ADIB, MD., PA
Entity type:Organization
Organization Name:DENNISSE RUIZ-ADIB, MD., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ-ADIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-985-0123
Mailing Address - Street 1:4001 W 15TH ST STE 480
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5853
Mailing Address - Country:US
Mailing Address - Phone:972-985-0123
Mailing Address - Fax:
Practice Address - Street 1:4001 W 15TH ST STE 480
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5853
Practice Address - Country:US
Practice Address - Phone:972-985-0123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7582207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty