Healthcare Provider Details

I. General information

NPI: 1336209352
Provider Name (Legal Business Name): ALBERTO A RUIZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4244 W LINEBAUGH AVE
TAMPA FL
33624-5241
US

IV. Provider business mailing address

11408 N 56TH ST
TEMPLE TERRACE FL
33617
US

V. Phone/Fax

Practice location:
  • Phone: 813-960-9080
  • Fax: 813-960-1090
Mailing address:
  • Phone: 813-980-6300
  • Fax: 813-988-3829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN12062
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: