Provider Demographics
NPI:1063849180
Name:CRUZ, OLIVER SILVESTRE (DDS)
Entity Type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:SILVESTRE
Last Name:CRUZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W 219TH ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2922
Mailing Address - Country:US
Mailing Address - Phone:310-594-4902
Mailing Address - Fax:
Practice Address - Street 1:5825 LINCOLN AVE STE H
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-3477
Practice Address - Country:US
Practice Address - Phone:310-594-4902
Practice Address - Fax:714-761-7179
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62551122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist