Healthcare Provider Details

I. General information

NPI: 1588364277
Provider Name (Legal Business Name): LIZ RUANO ABAD DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 N 56TH ST
TEMPLE TERRACE FL
33617-6203
US

IV. Provider business mailing address

8851 N 56TH ST
TEMPLE TERRACE FL
33617-6203
US

V. Phone/Fax

Practice location:
  • Phone: 813-381-5628
  • Fax:
Mailing address:
  • Phone: 813-381-5628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN28608
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: