Provider Demographics
NPI:1417463324
Name:RODRIGUEZ CRUZ DENTAL INC
Entity Type:Organization
Organization Name:RODRIGUEZ CRUZ DENTAL INC
Other - Org Name:RODRIGUEZ CRUZ DENTAL INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:626-839-0400
Mailing Address - Street 1:401 S AZUSA AVE # A
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-5111
Mailing Address - Country:US
Mailing Address - Phone:626-839-0400
Mailing Address - Fax:626-839-0490
Practice Address - Street 1:401 S AZUSA AVE # A
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-5111
Practice Address - Country:US
Practice Address - Phone:626-839-0400
Practice Address - Fax:626-839-0490
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALBERTO RODRIGUEZ CRUZ
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48006122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty