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General NPI Number Information
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NPI Number | 1083319602
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Entity Type | Individual
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Provider Name | NICOLE MARIE COLON CRUZ DMD
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Gender | Female
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Dates
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Enumeration Date | 04/03/2023
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Last Update Date | 08/02/2025
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Provider Practice Location Address
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Address Line | 36 CHAUNCY ST
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City | BOSTON
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State | MA
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Zip | 02111-2209
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Country | US
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Telephone | 617-338-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 35 LOMASNEY WAY APT 1712
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City | BOSTON
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State | MA
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Zip | 02114-1506
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Country | US
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Telephone | 787-547-2897
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN10000791
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License Number State | MA
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