Provider Demographics
NPI:1558698092
Name:CRUZ, DEO SOSITO (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEO
Middle Name:SOSITO
Last Name:CRUZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DEOGRACIAS
Other - Middle Name:SOSITO
Other - Last Name:CRUZ JR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1275 30TH ST.
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154
Mailing Address - Country:US
Mailing Address - Phone:619-662-4100
Mailing Address - Fax:619-231-6073
Practice Address - Street 1:3177 OCEANVIEW BLVD.
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113
Practice Address - Country:US
Practice Address - Phone:619-662-4100
Practice Address - Fax:619-231-6073
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55827122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist