Healthcare Provider Details

I. General information

NPI: 1730907114
Provider Name (Legal Business Name): EDGAR RUIZ ARAGON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 08/14/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 BREWER ST
ASHEBORO NC
27203-4896
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 336-610-7000
  • Fax: 336-610-7003
Mailing address:
  • Phone: 704-874-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14429
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: