Provider Demographics
NPI:1417155813
Name:SALVA CRUZ, GLADYS (DDS)
Entity Type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:
Last Name:SALVA CRUZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 W KETTLEMAN LN
Mailing Address - Street 2:STE 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:209-390-1846
Practice Address - Street 1:2314 W KETTLEMAN LN
Practice Address - Street 2:STE 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:209-390-1846
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51996122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist