Provider Demographics
NPI:1083293245
Name:CRUZ-HERNANDEZ, SAMANTHA (RDH)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:CRUZ-HERNANDEZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-2648
Mailing Address - Country:US
Mailing Address - Phone:857-383-1531
Mailing Address - Fax:
Practice Address - Street 1:174 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-1546
Practice Address - Country:US
Practice Address - Phone:617-666-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH90184124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist