NPIMap

Organization Active NPI

Martin Ruelas, DMD, PC

  • General Practice Dentistry
  • Peoria, IL
National Provider Identifier
1104098078
Registry record updated Mar 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MARTIN RUELAS, DMD, PC
Practice address
10330 N Juliet CT
Peoria, IL 61615-1199
Phone
(309) 243-8455
Fax
(309) 243-8466
NPI assigned
Mar 31, 2008
Last updated
Mar 31, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Martin Ruelas, DMDNPI 1528161320
Title
Dentist
Phone
(309) 243-8455

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

10330 N Juliet CT
Peoria, IL 61615-1199

Mailing address

PO Box 9423
Peoria, IL 61612-9423

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206921600000",
    "number": "1104098078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9423",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616129423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10330 N JULIET CT",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616151199",
            "telephone_number": "309-243-8455",
            "fax_number": "309-243-8466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN RUELAS, DMD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-31",
        "last_updated": "2008-03-31",
        "status": "A",
        "authorized_official_last_name": "RUELAS",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "309-243-8455",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.