MEDICARE: ELISEO RUIZ D.M.D

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	DN18793	FL

General Provider Information

NPI Number	:	1457589525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISEO RUIZ D.M.D

Provider Business Mailing Address
First Line	:	6915 MAIN ST APT 333
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-7007
Country	:	US
Telephone Number	:	786-262-0175
Fax Number	:

Provider Business Practice Location Address
First Line	:	8221 W FLAGLER ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-2027
Country	:	US
Telephone Number	:	305-266-7000
Fax Number	:	305-261-0397

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

Provider Enumeration Date	:	06/29/2009
Last Update Date	:	06/29/2009

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