Provider Demographics
NPI:1598920944
Name:CESAR CRUZ, DDS P.A.
Entity Type:Organization
Organization Name:CESAR CRUZ, DDS P.A.
Other - Org Name:UNIVERSAL DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CEESAR
Authorized Official - Middle Name:O
Authorized Official - Last Name:CRUZ ZAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-224-3131
Mailing Address - Street 1:808 N. CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:501-224-3131
Mailing Address - Fax:501-224-3132
Practice Address - Street 1:8500 W. MARKHAM ST.
Practice Address - Street 2:SUITE 331
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-224-3131
Practice Address - Fax:501-224-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3529122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163133608Medicaid