Provider Demographics
NPI:1134429251
Name:RUIZ, YARIMAR (DMD)
Entity type:Individual
Prefix:
First Name:YARIMAR
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19551 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33332
Mailing Address - Country:US
Mailing Address - Phone:954-790-0650
Mailing Address - Fax:
Practice Address - Street 1:19551 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINED
Practice Address - State:FL
Practice Address - Zip Code:00729-9625
Practice Address - Country:US
Practice Address - Phone:954-621-7959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2862122300000X
FLDN 199391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist