Provider Demographics
NPI:1457589525
Name:RUIZ, ELISEO (DMD)
Entity type:Individual
Prefix:
First Name:ELISEO
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6915 MAIN ST APT 333
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-7007
Mailing Address - Country:US
Mailing Address - Phone:786-262-0175
Mailing Address - Fax:
Practice Address - Street 1:8221 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2027
Practice Address - Country:US
Practice Address - Phone:305-266-7000
Practice Address - Fax:305-261-0397
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN187931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice