Provider Demographics
NPI:1104961663
Name:DR. ALBERT G RUEZGA, INC.
Entity type:Organization
Organization Name:DR. ALBERT G RUEZGA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:RUEZGA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-751-5888
Mailing Address - Street 1:2340 E CALVADA BLVD
Mailing Address - Street 2:1
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-5880
Mailing Address - Country:US
Mailing Address - Phone:775-751-5888
Mailing Address - Fax:775-751-1573
Practice Address - Street 1:2340 E CALVADA BLVD
Practice Address - Street 2:1
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5880
Practice Address - Country:US
Practice Address - Phone:775-751-5888
Practice Address - Fax:775-751-1573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4065122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty