Provider Demographics
NPI:1114586369
Name:CRUZ, JACLYN LEE RABADI (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:LEE RABADI
Last Name:CRUZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JACLYN
Other - Middle Name:LEE
Other - Last Name:RABADI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:60 N 23RD ST APT 305
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1580
Mailing Address - Country:US
Mailing Address - Phone:845-750-5649
Mailing Address - Fax:
Practice Address - Street 1:509 S LENOLA RD BLDG 3A
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-1561
Practice Address - Country:US
Practice Address - Phone:856-778-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN0032571223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics