MEDICARE: DR. JOSE GILBERTO 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	DN 18111	FL

General Provider Information

NPI Number	:	1538351556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE GILBERTO CRUZ D.D.S.

Provider Business Mailing Address
First Line	:	6390 CYPRESS GARDENS BLVD
Second Line	:	STE B
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-3176
Country	:	US
Telephone Number	:	863-324-7121
Fax Number	:

Provider Business Practice Location Address
First Line	:	6390 CYPRESS GARDENS BLVD
Second Line	:	STE B
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-3176
Country	:	US
Telephone Number	:	863-324-7121
Fax Number	:

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

Provider Enumeration Date	:	08/14/2007
Last Update Date	:	08/14/2007

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