| Organization Name: | RUTH B GARZON DENTAL PRACTICE INC |
| NPI Number: | 1033241260 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RUTH B GARZON (OWNER DENTIST) |
| Mailing Address: | 509 Five Cities Dr Pismo Beach |
| State: | CA US |
| Postal Code: | 93449 |
| Phone Number: | 8057732131 |
| Fax Number: | 8057738656 |
| NPI Enumeration Date: | 03/12/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 50913 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |