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General NPI Number Information
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NPI Number | 1194280545
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Entity Type | Organization
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Legal Business Name | OLIVER S. CRUZ, DDS, INC.
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Dates
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Enumeration Date | 02/08/2019
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Last Update Date | 02/08/2019
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Provider Practice Location Address
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Address Line | 5825 LINCOLN AVE STE H
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City | BUENA PARK
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State | CA
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Zip | 90620-3477
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Country | US
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Telephone | 714-761-1736
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Fax | 714-761-1736
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Provider Business Mailing Address
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Address Line | 5825 LINCOLN AVE STE H
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City | BUENA PARK
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State | CA
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Zip | 90620-3477
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Country | US
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Telephone | 714-761-1736
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Fax | 714-761-7179
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Authorized Official
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Title or Position | DENTIST / OWNER / PRESIDENT
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Name | DR. OLIVER SILVESTRE CRUZ
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Credential | DDS
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Telephone | 310-594-4902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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