MEDICARE: DR. MARIA ELENA CRUZ D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2045	PR

General Provider Information

NPI Number	:	1396781662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA ELENA CRUZ D.D.S.

Provider Business Mailing Address
First Line	:	1475 CALLE WILSON
Second Line	:	SUITE 1-A
City	:	SAN JUAN
State	:	PR
Zip	:	00907-2357
Country	:	US
Telephone Number	:	787-728-6165
Fax Number	:	787-728-4974

Provider Business Practice Location Address
First Line	:	1475 CALLE WILSON
Second Line	:	SUITE 1-A
City	:	SAN JUAN
State	:	PR
Zip	:	00907-2357
Country	:	US
Telephone Number	:	787-728-6165
Fax Number	:	787-728-4974

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/08/2007

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