Provider Demographics
NPI:1356353098
Name:ALBERT RUIZ DDS FAMILY & COSMETIC DENTISTRY LLC
Entity type:Organization
Organization Name:ALBERT RUIZ DDS FAMILY & COSMETIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:863-385-6200
Mailing Address - Street 1:529 US HWY 27 SOUTH
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-2108
Mailing Address - Country:US
Mailing Address - Phone:863-385-6200
Mailing Address - Fax:863-386-0770
Practice Address - Street 1:529 US HWY 27 SOUTH
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-2108
Practice Address - Country:US
Practice Address - Phone:863-385-6200
Practice Address - Fax:863-386-0770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00127841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL69077OtherBCBS
FL706644OtherUNITED CONCORDIA