Healthcare Provider Details

I. General information

NPI: 1679379390
Provider Name (Legal Business Name): CRUZ DE LA CRUZ PROSTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2025
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 AVE ASHFORD STE 201
SAN JUAN PR
00907-1137
US

IV. Provider business mailing address

URB MONTE ORO 1 CAMINO EL MUDO APT 21
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-998-7778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: ANGEL DAMIAN CRUZ DE LA CRUZ
Title or Position: PROSTHODONTIST
Credential: DMD
Phone: 787-998-7778