Provider Demographics
NPI:1083883508
Name:GLADYS SALVA CRUZ DDS INC
Entity Type:Organization
Organization Name:GLADYS SALVA CRUZ DDS INC
Other - Org Name:LODI HEALTHY SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:RIVERA
Authorized Official - Last Name:SALVA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-310-3523
Mailing Address - Street 1:2314 W KETTLEMAN LN
Mailing Address - Street 2:109
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-4126
Mailing Address - Country:US
Mailing Address - Phone:209-369-9800
Mailing Address - Fax:209-369-9800
Practice Address - Street 1:2314 W KETTLEMAN LN
Practice Address - Street 2:109
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-4126
Practice Address - Country:US
Practice Address - Phone:209-369-9800
Practice Address - Fax:209-369-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty