Provider Demographics
NPI:1376821413
Name:CRUZ, WHERTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:WHERTER
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7818 VILLA RAMA SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-7968
Mailing Address - Country:US
Mailing Address - Phone:956-581-5391
Mailing Address - Fax:
Practice Address - Street 1:PORFIRIO DIAZ NO. 1100 Z. CENTRO
Practice Address - Street 2:
Practice Address - City:REYNOSA
Practice Address - State:TAMPS
Practice Address - Zip Code:88500
Practice Address - Country:MX
Practice Address - Phone:899-922-1819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ2753493122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist