Individual
DR. OMAR ALEJANDRO PENA RUIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2508 BERT KOUNS INDUSTRIAL LOOP, SHREVEPORT, LA 71118-3133
(318) 212-5210
Mailing address
200 MAJESTIC OAKS DR APT 202, SHREVEPORT, LA 71115-3879
(787) 525-0945
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
S-1220
LA
Other
Enumeration date
03/21/2025
Last updated
09/30/2025
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