MEDICARE: JUNIOR GUTIERREZ CRUZ DDS

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	122300000X	Dentist	7621	OK
2	122300000X	Dentist	38493	TX

General Provider Information

NPI Number	:	1760114193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUNIOR GUTIERREZ CRUZ DDS

Provider Business Mailing Address
First Line	:	3112 SUNDIAL DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-3756
Country	:	US
Telephone Number	:	469-647-8107
Fax Number	:

Provider Business Practice Location Address
First Line	:	4253 CEDAR SPRINGS RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-2691
Country	:	US
Telephone Number	:	214-522-4444
Fax Number	:

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

Provider Enumeration Date	:	06/24/2022
Last Update Date	:	03/24/2026

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