Provider Demographics
NPI:1003102708
Name:CRUZ-DAVIS, YULIEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:YULIEN
Middle Name:
Last Name:CRUZ-DAVIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12425 SW 154TH ST
Mailing Address - Street 2:
Mailing Address - City:ARCHER
Mailing Address - State:FL
Mailing Address - Zip Code:32618-4119
Mailing Address - Country:US
Mailing Address - Phone:305-766-4165
Mailing Address - Fax:
Practice Address - Street 1:2845 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6649
Practice Address - Country:US
Practice Address - Phone:352-384-0050
Practice Address - Fax:352-384-0051
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN193851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice