Provider Demographics
NPI:1922452523
Name:MIGUEL A. RIUZ, DDS. PA
Entity Type:Organization
Organization Name:MIGUEL A. RIUZ, DDS. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:936-539-6000
Mailing Address - Street 1:600 RIVER POINTE DR
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2866
Mailing Address - Country:US
Mailing Address - Phone:936-539-6000
Mailing Address - Fax:936-539-6002
Practice Address - Street 1:600 RIVER POINTE DR
Practice Address - Street 2:SUITE 200A
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2866
Practice Address - Country:US
Practice Address - Phone:936-539-6000
Practice Address - Fax:936-539-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139347217Medicaid