Provider Demographics
NPI:1992168959
Name:JOSE-LUIS RUIZ D.D.S., A.P.C.
Entity type:Organization
Organization Name:JOSE-LUIS RUIZ D.D.S., A.P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE-LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,, FAGD
Authorized Official - Phone:818-558-4332
Mailing Address - Street 1:11966 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2606
Mailing Address - Country:US
Mailing Address - Phone:818-641-5577
Mailing Address - Fax:818-245-9339
Practice Address - Street 1:11966 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2606
Practice Address - Country:US
Practice Address - Phone:818-641-5577
Practice Address - Fax:818-245-9339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA381241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty