Provider Demographics
NPI:1619712619
Name:RUANO, SELINA ESMERALDA (DDS)
Entity type:Individual
Prefix:DR
First Name:SELINA
Middle Name:ESMERALDA
Last Name:RUANO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11914 TROULON DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-4030
Mailing Address - Country:US
Mailing Address - Phone:832-661-1113
Mailing Address - Fax:
Practice Address - Street 1:110 W DEQUEEN AVE STE B
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-2877
Practice Address - Country:US
Practice Address - Phone:870-642-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX405381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice