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General NPI Number Information
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NPI Number | 1609204726
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Entity Type | Organization
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Legal Business Name | EDWARD M. RUIZ DDS PC
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 17901 GOVERNORS HWY SUITE 201A
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City | HOMEWOOD
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State | IL
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Zip | 60430-1144
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Country | US
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Telephone | 708-798-8899
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Fax | 708-798-3923
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Provider Business Mailing Address
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Address Line | 17901 GOVERNORS HWY SUITE 201A
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City | HOMEWOOD
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State | IL
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Zip | 60430-1144
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Country | US
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Telephone | 708-798-8899
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Fax | 708-798-3923
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. EDWARD M RUIZ
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Credential | DDS
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Telephone | 708-798-8899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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