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General NPI Number Information
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NPI Number | 1841004751
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Entity Type | Individual
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Provider Name | JUAN RUIZ
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Gender | Male
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 3924 S ARCHER AVE STE D
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City | CHICAGO
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State | IL
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Zip | 60632-1193
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Country | US
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Telephone | 773-819-7101
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Fax |
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Provider Business Mailing Address
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Address Line | 635 ALBANY ST
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City | BOSTON
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State | MA
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Zip | 02118-3550
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Country | US
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Telephone | 617-358-8300
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Fax |
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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 | 019036494
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License Number State | IL
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