Provider Demographics
NPI:1902582679
Name:LUNA-RUIZ, BIANCA MICHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:MICHELLE
Last Name:LUNA-RUIZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:HATCH
Mailing Address - State:NM
Mailing Address - Zip Code:87937
Mailing Address - Country:US
Mailing Address - Phone:575-267-3280
Mailing Address - Fax:575-267-1747
Practice Address - Street 1:125 CHAPARREL BLVD NW
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-8629
Practice Address - Country:US
Practice Address - Phone:575-546-4800
Practice Address - Fax:575-546-0685
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011868122300000X
NMDB-2024-0075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist