Provider Demographics
NPI:1699883470
Name:RUIZ, SHARLA JEAN (DMD)
Entity type:Individual
Prefix:DR
First Name:SHARLA
Middle Name:JEAN
Last Name:RUIZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W MISSION RD
Mailing Address - Street 2:#B
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-5900
Mailing Address - Country:US
Mailing Address - Phone:760-728-6123
Mailing Address - Fax:
Practice Address - Street 1:111 W MISSION RD
Practice Address - Street 2:#B
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-5900
Practice Address - Country:US
Practice Address - Phone:760-728-6123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB38909122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist