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General NPI Number Information
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NPI Number | 1295938447
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Entity Type | Organization
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Legal Business Name | ETHEL CRUZ DMD INC
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 5814 RIVERSIDE DRIVE
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City | CHINO
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State | CA
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Zip | 91710
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Country | US
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Telephone | 909-548-4844
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Fax | 909-548-0774
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Provider Business Mailing Address
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Address Line | 5814 RIVERSIDE DRIVE
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City | CHINO
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State | CA
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Zip | 91710
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Country | US
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Telephone | 909-548-4844
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Fax | 909-548-0774
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Authorized Official
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Title or Position | OWNER
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Name | MS. ETHEL S CRUZ
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Credential |
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Telephone | 909-548-4844
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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 | 51913
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License Number State | CA
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