MEDICARE: DR. RAYMOND A SANTA-CRUZ DMD

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	332B00000X	Durable Medical Equipment & Medical Supplies	DN20079	FL
2	122300000X	Dentist	DN20079	FL

General Provider Information

NPI Number	:	1306281522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND A SANTA-CRUZ DMD

Provider Business Mailing Address
First Line	:	4104 LITTLE RD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-1721
Country	:	US
Telephone Number	:	727-376-2666
Fax Number	:	727-245-8864

Provider Business Practice Location Address
First Line	:	4104 LITTLE RD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-1721
Country	:	US
Telephone Number	:	727-376-2666
Fax Number	:	727-245-8864

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

Provider Enumeration Date	:	05/01/2013
Last Update Date	:	08/19/2019

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Directions to “ DR. RAYMOND A SANTA-CRUZ DMD” Practice Location

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