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General NPI Number Information
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NPI Number | 1356465462
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Entity Type | Individual
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Provider Name | LUIS A. CRUZ DMD
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Gender | Male
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 01/08/2009
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Provider Practice Location Address
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Address Line | 105 CYPRESS POINT PKWY SUITE D
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City | PALM COAST
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State | FL
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Zip | 32164-8428
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Country | US
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Telephone | 386-439-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 105 CYPRESS POINT PKWY SUITE D
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City | PALM COAST
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State | FL
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Zip | 32164-8428
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Country | US
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Telephone | 386-439-5437
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN17507
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License Number State | FL
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