MEDICARE: DR. JORDANA LEAH CONTRUCCI RUIZ DMD

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	31300	TX

General Provider Information

NPI Number	:	1902281678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDANA LEAH CONTRUCCI RUIZ DMD

Provider Business Mailing Address
First Line	:	7777 FOREST LN STE C104
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-6830
Country	:	US
Telephone Number	:	954-562-2199
Fax Number	:	972-566-4993

Provider Business Practice Location Address
First Line	:	7777 FOREST LN STE C104
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-6830
Country	:	US
Telephone Number	:	972-566-4990
Fax Number	:	972-566-4993

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

Provider Enumeration Date	:	07/23/2015
Last Update Date	:	09/14/2019

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