Provider Demographics
NPI:1174268940
Name:CRUZIN' DENTAL PA
Entity Type:Organization
Organization Name:CRUZIN' DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTA-CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-909-5589
Mailing Address - Street 1:3003 LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1463
Mailing Address - Country:US
Mailing Address - Phone:239-369-0019
Mailing Address - Fax:239-369-1015
Practice Address - Street 1:3003 LEE BLVD
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1463
Practice Address - Country:US
Practice Address - Phone:239-369-0019
Practice Address - Fax:239-369-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty