Provider Demographics
NPI:1639172109
Name:CRUZ, CARLOS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 CORNERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539
Mailing Address - Country:US
Mailing Address - Phone:956-627-3556
Mailing Address - Fax:956-627-3762
Practice Address - Street 1:2405 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-627-3556
Practice Address - Fax:956-627-3762
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX188681223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1107690016OtherMEDICAID DENTAL
110769017OtherCSHCN
TX110769015Medicaid
X0100636OtherDPS
BC5175105OtherDEA
TXU63930Medicare UPIN
TXB115051Medicare PIN