Healthcare Provider Details

I. General information

NPI: 1114250131
Provider Name (Legal Business Name): KATIANA CRUET DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8955 WOOD RD
BETHESDA MD
20889-2111
US

IV. Provider business mailing address

5459 WHITLEY PARK TER
BETHESDA MD
20814-2034
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-7861
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDEN.00204583
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: