MEDICARE: PEDRO LUIS PEREIRA-RUIZ DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2639	PR

General Provider Information

NPI Number	:	1376519595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEDRO LUIS PEREIRA-RUIZ DMD

Provider Business Mailing Address
First Line	:	PO BOX 1902
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00984-1902
Country	:	US
Telephone Number	:	787-565-8089
Fax Number	:

Provider Business Practice Location Address
First Line	:	BH12 CALLE 110
Second Line	:	VALLE ARRIBA HEIGHTS
City	:	CAROLINA
State	:	PR
Zip	:	00983-3309
Country	:	US
Telephone Number	:	787-768-3500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	07/09/2007

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