MEDICARE: KENDRA LILENIA CRUZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN29329	FL

General Provider Information

NPI Number	:	1053158477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA LILENIA CRUZ

Provider Business Mailing Address
First Line	:	15530 MARK LN UNIT 3110
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-9919
Country	:	US
Telephone Number	:	941-993-3602
Fax Number	:

Provider Business Practice Location Address
First Line	:	2905 DAVIS BLVD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34104-4338
Country	:	US
Telephone Number	:	239-331-5660
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2024
Last Update Date	:	07/12/2024

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Directions to “ KENDRA LILENIA CRUZ ” Practice Location

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