Provider Demographics
NPI:1558788562
Name:ASHFORD DENTAL PSC
Entity Type:Organization
Organization Name:ASHFORD DENTAL PSC
Other - Org Name:ASHFORD DENTAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROSTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MMSC
Authorized Official - Phone:787-998-7778
Mailing Address - Street 1:1018 ASHFORD AVENUE
Mailing Address - Street 2:COND. CONDADO ASTOR SUITE 201
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:UM
Mailing Address - Phone:787-998-7778
Mailing Address - Fax:787-998-7487
Practice Address - Street 1:1018 AVE ASHFORD
Practice Address - Street 2:COND. CONDADO ASTOR SUITE 201
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1100
Practice Address - Country:US
Practice Address - Phone:787-998-7778
Practice Address - Fax:787-998-7487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR31551223E0200X
PR31531223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty