Provider Demographics
NPI:1659565232
Name:CRUZ, OMAR R (DMD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:R
Last Name:CRUZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6898
Mailing Address - Country:US
Mailing Address - Phone:773-528-0068
Mailing Address - Fax:773-528-0088
Practice Address - Street 1:1426 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6898
Practice Address - Country:US
Practice Address - Phone:773-528-0068
Practice Address - Fax:773-528-0088
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190270751223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics