Healthcare Provider Details

I. General information

NPI: 1639749146
Provider Name (Legal Business Name): ANA LUCIA RUZO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 S VINE ST STE L-20
CENTENNIAL CO
80121-2773
US

IV. Provider business mailing address

7139 HILLGREEN DR
DALLAS TX
75214-1933
US

V. Phone/Fax

Practice location:
  • Phone: 303-795-7674
  • Fax:
Mailing address:
  • Phone: 214-629-2651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number205318
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7476
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: