Provider Demographics
NPI:1760114193
Name:CRUZ, JUNIOR GUTIERREZ (DDS)
Entity Type:Individual
Prefix:
First Name:JUNIOR
Middle Name:GUTIERREZ
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 1:3112 SUNDIAL DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-3756
Mailing Address - Country:US
Mailing Address - Phone:469-647-8107
Mailing Address - Fax:
Practice Address - Street 1:2123 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1214
Practice Address - Country:US
Practice Address - Phone:405-907-1398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7621122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist