Provider Demographics
NPI:1902281678
Name:RUIZ, JORDANA LEAH CONTRUCCI (DMD)
Entity Type:Individual
Prefix:DR
First Name:JORDANA
Middle Name:LEAH CONTRUCCI
Last Name:RUIZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN STE C104
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6830
Mailing Address - Country:US
Mailing Address - Phone:954-562-2199
Mailing Address - Fax:972-566-4993
Practice Address - Street 1:7777 FOREST LN STE C104
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6830
Practice Address - Country:US
Practice Address - Phone:972-566-4990
Practice Address - Fax:972-566-4993
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2019-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist