Provider Demographics
NPI:1144841347
Name:FERNANDEZ RUIZ, JASSEL (DDS)
Entity type:Individual
Prefix:
First Name:JASSEL
Middle Name:
Last Name:FERNANDEZ RUIZ
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 1:235 HILLIARD RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-4704
Mailing Address - Country:US
Mailing Address - Phone:254-410-0882
Mailing Address - Fax:
Practice Address - Street 1:235 HILLIARD RD
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-4704
Practice Address - Country:US
Practice Address - Phone:254-410-0882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX403721223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery