Provider Demographics
NPI:1689667289
Name:DIAZ-RUIZ, EDGAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:
Last Name:DIAZ-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 1:584 CALLE CAPRI
Mailing Address - Street 2:EXT. EL COMANDANTE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982-3626
Mailing Address - Country:US
Mailing Address - Phone:787-752-4686
Mailing Address - Fax:787-762-5220
Practice Address - Street 1:467 CALLE DE DIEGO
Practice Address - Street 2:RIO PIEDRAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-7002
Practice Address - Country:US
Practice Address - Phone:787-762-5220
Practice Address - Fax:787-762-5220
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR021211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice