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General NPI Number Information
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NPI Number | 1619775822
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Entity Type | Individual
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Provider Name | LAURA NATALIA MARIN RUIZ
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Gender | Female
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 444 STOCKBRIDGE RD
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City | GREAT BARRINGTON
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State | MA
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Zip | 01230-1295
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Country | US
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Telephone | 413-854-2805
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Fax |
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Provider Business Mailing Address
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Address Line | 105 LAUREL ST APT 11A
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City | LEE
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State | MA
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Zip | 01238-1203
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Country | US
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Telephone | 904-450-0155
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Fax | 904-450-0155
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DL100638
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License Number State | MA
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