MEDICARE: WALDEMAR RUIZ DMD MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	3896	OK

General Provider Information

NPI Number	:	1285772707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALDEMAR RUIZ DMD MS

Provider Business Mailing Address
First Line	:	8811 E RENO
Second Line	:	SUITE 101
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-7726
Country	:	US
Telephone Number	:	405-732-6729
Fax Number	:	405-732-7191

Provider Business Practice Location Address
First Line	:	8811 E RENO
Second Line	:	SUITE 101
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-7726
Country	:	US
Telephone Number	:	405-732-6729
Fax Number	:	405-732-7191

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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