Provider Demographics
NPI:1629136015
Name:BALDASSARI-CRUZ, LYNNE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:A
Last Name:BALDASSARI-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 1:405 EL CAMINO REAL
Mailing Address - Street 2:#622
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-5240
Mailing Address - Country:US
Mailing Address - Phone:650-380-1337
Mailing Address - Fax:650-376-3326
Practice Address - Street 1:1028 LAUREL ST
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3919
Practice Address - Country:US
Practice Address - Phone:650-595-3722
Practice Address - Fax:650-595-3636
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA383951223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics