MEDICARE: HENRY J. RAMIREZ, D.D.S., INC.

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	27823	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27823	OTHER	CA	DENTAL LICENSE

General Provider Information

NPI Number	:	1790883098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY J. RAMIREZ, D.D.S., INC.

Provider Business Mailing Address
First Line	:	1016 SOQUEL AVE
Second Line	:	STE. A
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-2104
Country	:	US
Telephone Number	:	831-423-2447
Fax Number	:	831-423-7925

Provider Business Practice Location Address
First Line	:	1016 SOQUEL AVE
Second Line	:	STE. A
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-2104
Country	:	US
Telephone Number	:	831-423-2447
Fax Number	:	831-423-7925

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HENRY JOHN RAMIREZ
Credential	:	D.D.S.
Telephone Number	:	831-423-2447

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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