Healthcare Provider Details

I. General information

NPI: 1689977951
Provider Name (Legal Business Name): DENTAL SOLUTIONS OF WINTER HAVEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6390 CYPRESS GARDENS BLVD
WINTER HAVEN FL
33884-3176
US

IV. Provider business mailing address

6390 CYPRESS GARDENS BLVD
WINTER HAVEN FL
33884-3176
US

V. Phone/Fax

Practice location:
  • Phone: 863-324-7121
  • Fax: 863-324-7056
Mailing address:
  • Phone: 863-324-7121
  • Fax: 863-324-7056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE GILBERTO CRUZ
Title or Position: MANAGER
Credential: DDS
Phone: 863-324-7121