Provider Demographics
NPI:1740391648
Name:RUIZ, MICHELLE NANESE (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:NANESE
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 1:2017 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-1330
Mailing Address - Country:US
Mailing Address - Phone:806-373-5751
Mailing Address - Fax:
Practice Address - Street 1:1600 S COULTER ST
Practice Address - Street 2:BLDG G, SUITE 500
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1710
Practice Address - Country:US
Practice Address - Phone:806-351-2762
Practice Address - Fax:806-351-2763
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX179101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1571853 01Medicaid
TXG60131 01OtherCHIPS