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General NPI Number Information
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NPI Number | 1467612614
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Entity Type | Individual
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Provider Name | CARLOS M CRUZ CHU
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Gender | Male
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Dates
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Enumeration Date | 06/11/2008
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Last Update Date | 07/07/2022
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Provider Practice Location Address
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Address Line | 221 PARK HILL DR
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-3361
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Country | US
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Telephone | 540-228-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 11319 TYRELL CT
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-1766
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Country | US
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Telephone | 860-707-0646
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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 | 0401413975
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License Number State | VA
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