Provider Demographics
NPI:1770579914
Name:RUIZ, JOSE A (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:RUIZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:A
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:254 CALLE SAN NARCISO
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-2960
Mailing Address - Country:US
Mailing Address - Phone:787-868-5958
Mailing Address - Fax:787-868-5958
Practice Address - Street 1:254 CALLE SAN NARCISO
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-2960
Practice Address - Country:US
Practice Address - Phone:787-868-5958
Practice Address - Fax:787-868-5958
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice