MEDICARE: DR. VITO H RUIZ DDS

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	122300000X	Dentist	10993	TX

General Provider Information

NPI Number	:	1508947573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VITO H RUIZ DDS

Provider Business Mailing Address
First Line	:	PO BOX 2729
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78044
Country	:	US
Telephone Number	:	956-724-4952
Fax Number	:	969-724-4154

Provider Business Practice Location Address
First Line	:	2219 O KANE
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78043
Country	:	US
Telephone Number	:	956-724-4952
Fax Number	:	956-724-4254

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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