Provider Demographics
NPI:1659866887
Name:RUIZ, VICTORIA (DDS)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
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 1:4114 MEDICAL DR APT 13306
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5661
Mailing Address - Country:US
Mailing Address - Phone:956-414-9910
Mailing Address - Fax:
Practice Address - Street 1:2120 W OAKLAWN RD UNIT E
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064-4623
Practice Address - Country:US
Practice Address - Phone:830-268-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty