Healthcare Provider Details

I. General information

NPI: 1871997106
Provider Name (Legal Business Name): MARISOL RUIZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7280 W PALMETTO PARK RD SUITE 206-N
BOCA RATON FL
33433-3422
US

IV. Provider business mailing address

7280 W PALMETTO PARK RD SUITE 206-N
BOCA RATON FL
33433-3422
US

V. Phone/Fax

Practice location:
  • Phone: 561-395-0550
  • Fax: 561-395-5272
Mailing address:
  • Phone: 561-395-0550
  • Fax: 561-395-5272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN0012544
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN7316
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN8339
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN19915
License Number StateFL

VIII. Authorized Official

Name: MARISOL RUIZ
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 561-395-0550