MEDICARE: DR. ANA LUCIA RUZO DDS

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	122300000X	Dentist	205318	CO
2	122300000X	Dentist	7476	OK

General Provider Information

NPI Number	:	1639749146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANA LUCIA RUZO DDS

Provider Business Mailing Address
First Line	:	7139 HILLGREEN DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-1933
Country	:	US
Telephone Number	:	214-629-2651
Fax Number	:

Provider Business Practice Location Address
First Line	:	6650 S VINE ST STE L-20
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80121-2773
Country	:	US
Telephone Number	:	303-795-7674
Fax Number	:

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

Provider Enumeration Date	:	06/28/2021
Last Update Date	:	08/03/2023

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