Provider Demographics
NPI:1073613758
Name:CRUZ, ANNA BELLE C (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANNA BELLE
Middle Name:C
Last Name:CRUZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ANNA BELLE
Other - Middle Name:A
Other - Last Name:CUYONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:17510 PIONEER BLVD
Mailing Address - Street 2:STE. 201
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-4007
Mailing Address - Country:US
Mailing Address - Phone:562-402-4952
Mailing Address - Fax:562-402-8195
Practice Address - Street 1:17510 PIONEER BLVD
Practice Address - Street 2:STE. 201
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-4007
Practice Address - Country:US
Practice Address - Phone:562-402-4952
Practice Address - Fax:562-402-8195
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB37092-02OtherMEDICAL/DENTICAL