Provider Demographics
NPI:1275637969
Name:GONZALEZ, RUTH CHRISTINE (DDS)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:CHRISTINE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19601 N BLACK CANYON HWY
Mailing Address - Street 2:#201
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4107
Mailing Address - Country:US
Mailing Address - Phone:319-365-9105
Mailing Address - Fax:319-866-9662
Practice Address - Street 1:4747 E BELL RD STE
Practice Address - Street 2:#15
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032
Practice Address - Country:US
Practice Address - Phone:319-365-9105
Practice Address - Fax:319-866-9662
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08433122300000X
IAPERMIT40085122300000X
AZD008858122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1474544Medicare PIN