Provider Demographics
NPI:1649906280
Name:RUIZ, OSCAR (MDM)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:MDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1456
Mailing Address - Street 2:
Mailing Address - City:LITTLEFIELD
Mailing Address - State:AZ
Mailing Address - Zip Code:86432-1456
Mailing Address - Country:US
Mailing Address - Phone:435-215-3658
Mailing Address - Fax:
Practice Address - Street 1:2050 S BLOSSER RD
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-7310
Practice Address - Country:US
Practice Address - Phone:805-346-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1076021223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health