Provider Demographics
NPI:1902229669
Name:RUBEN HURTADO DDS INC
Entity Type:Organization
Organization Name:RUBEN HURTADO DDS INC
Other - Org Name:EL CAMINO DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HURTADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-312-7099
Mailing Address - Street 1:15517 CERISE AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-4417
Mailing Address - Country:US
Mailing Address - Phone:786-312-7099
Mailing Address - Fax:
Practice Address - Street 1:15655 HAWTHORNE BLVD
Practice Address - Street 2:SUITE A-B
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2665
Practice Address - Country:US
Practice Address - Phone:424-297-0513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59291261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental