Provider Demographics
NPI:1760740328
Name:CRUZ, GLADYS E (DMD)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:E
Last Name:CRUZ
Suffix:
Gender:F
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:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-0060
Mailing Address - Country:US
Mailing Address - Phone:787-813-9088
Mailing Address - Fax:
Practice Address - Street 1:3606 FAIRMONT PKWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-3008
Practice Address - Country:US
Practice Address - Phone:787-813-9088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR31621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice