Provider Demographics
NPI:1851280002
Name:MARTIN RUIZ, ANDREA VANESSA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:VANESSA
Last Name:MARTIN RUIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 W JUNIATA ST
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2111
Mailing Address - Country:US
Mailing Address - Phone:352-241-2021
Mailing Address - Fax:
Practice Address - Street 1:659 W JUNIATA ST
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2111
Practice Address - Country:US
Practice Address - Phone:352-241-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN306711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice