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NPI Code Detail

MEDICARE: LUIS DANIEL RUIZ GONZALEZ RDH

MEDICARE: LUIS DANIEL RUIZ GONZALEZ RDH
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
1124Q00000XDental Hygienist020.016942IL
2124Q00000XDental Hygienist7001565-16WI

General Provider Information

NPI Number : 1407503279
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUIS DANIEL RUIZ GONZALEZ RDH
Provider Business Mailing Address
First Line : 866 PINE HILL DR
Second Line :
City : ANTIOCH
State : IL
Zip : 60002-1877
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4006 WASHINGTON RD
Second Line :
City : KENOSHA
State : WI
Zip : 53144-4819
Country : US
Telephone Number : 262-771-3553
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2022
Last Update Date : 07/17/2025

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