Provider Demographics
NPI:1285772707
Name:RUIZ, WALDEMAR (DMD MS)
Entity type:Individual
Prefix:
First Name:WALDEMAR
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8811 E RENO
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-7726
Mailing Address - Country:US
Mailing Address - Phone:405-732-6729
Mailing Address - Fax:405-732-7191
Practice Address - Street 1:8811 E RENO
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-7726
Practice Address - Country:US
Practice Address - Phone:405-732-6729
Practice Address - Fax:405-732-7191
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK38961223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics