Organization
MARTIN RUELAS, DMD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARTIN RUELAS DMD (DENTIST)
(309) 243-8455
Entity
Organization
Contact information
Practice address
10330 N JULIET CT, PEORIA, IL 61615-1199
(309) 243-8455
(309) 243-8466
Mailing address
PO BOX 9423, PEORIA, IL 61612-9423
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1035425/1004935
—
IL
Enumeration date
03/31/2008
Last updated
03/31/2008
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