Provider Demographics
NPI:1861550998
Name:RUIZ, PEDRO E (DMD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:E
Last Name:RUIZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202A CAROL DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-3895
Mailing Address - Country:US
Mailing Address - Phone:787-507-4183
Mailing Address - Fax:
Practice Address - Street 1:2360 THAIN GRD
Practice Address - Street 2:ASPEN DENTAL
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501
Practice Address - Country:US
Practice Address - Phone:208-298-2405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR27171223G0001X
ID48851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice