Provider Demographics
NPI:1679379390
Name:CRUZ DE LA CRUZ PROSTHODONTICS LLC
Entity type:Organization
Organization Name:CRUZ DE LA CRUZ PROSTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:DAMIAN
Authorized Official - Last Name:CRUZ DE LA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-998-7778
Mailing Address - Street 1:1211 CALLE 62 SE
Mailing Address - Street 2:REPARTO METROPOLITANO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1018 AVE ASHFORD STE 201
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1137
Practice Address - Country:US
Practice Address - Phone:787-998-7778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental