MEDICARE: CRUZ DE LA CRUZ PROSTHODONTICS LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1679379390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRUZ DE LA CRUZ PROSTHODONTICS LLC

Provider Business Mailing Address
First Line	:	URB MONTE ORO
Second Line	:	1 CAMINO EL MUDO APT 21
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1018 AVE ASHFORD STE 201
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1137
Country	:	US
Telephone Number	:	787-998-7778
Fax Number	:

Authorized Official
Title or Position	:	PROSTHODONTIST
Name	:	ANGEL DAMIAN CRUZ DE LA CRUZ
Credential	:	DMD
Telephone Number	:	787-998-7778

Provider Enumeration Date	:	02/22/2025
Last Update Date	:	10/04/2025

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