Provider Demographics
NPI:1447619820
Name:RUIZ RODRIGUEZ, JULIAN (DDS)
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:
Last Name:RUIZ RODRIGUEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18111 NW 68TH AVE APT I204
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3956
Mailing Address - Country:US
Mailing Address - Phone:786-278-0058
Mailing Address - Fax:
Practice Address - Street 1:18111 NW 68TH AVE APT I204
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3956
Practice Address - Country:US
Practice Address - Phone:786-278-0058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN229621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice