MEDICARE: DENTAL SOLUTIONS OF WINTER HAVEN

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
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1689977951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL SOLUTIONS OF WINTER HAVEN

Provider Business Mailing Address
First Line	:	6390 CYPRESS GARDENS BLVD
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-3176
Country	:	US
Telephone Number	:	863-324-7121
Fax Number	:	863-324-7056

Provider Business Practice Location Address
First Line	:	6390 CYPRESS GARDENS BLVD
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-3176
Country	:	US
Telephone Number	:	863-324-7121
Fax Number	:	863-324-7056

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. JOSE GILBERTO CRUZ
Credential	:	DDS
Telephone Number	:	863-324-7121

Provider Enumeration Date	:	12/08/2010
Last Update Date	:	09/30/2022

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