Healthcare Provider Details

I. General information

NPI: 1902582679
Provider Name (Legal Business Name): BIANCA MICHELLE LUNA-RUIZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CHAPARREL BLVD NW
DEMING NM
88030-8629
US

IV. Provider business mailing address

PO BOX 370
HATCH NM
87937
US

V. Phone/Fax

Practice location:
  • Phone: 575-546-4800
  • Fax: 575-546-0685
Mailing address:
  • Phone: 575-267-3280
  • Fax: 575-267-1747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD011868
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDB-2024-0075
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: