Healthcare Provider Details

I. General information

NPI: 1679610620
Provider Name (Legal Business Name): AIDA CRUZ RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 E MAIN ST 3RD FLOOR DENTAL HYGIENE
BRIDGEPORT CT
06608-2335
US

IV. Provider business mailing address

752 E MAIN ST 3RD FLOOR DENTAL HYGIENE
BRIDGEPORT CT
06608-2335
US

V. Phone/Fax

Practice location:
  • Phone: 203-576-7441
  • Fax: 203-576-8311
Mailing address:
  • Phone: 203-576-7441
  • Fax: 203-576-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number0012433
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: