Provider Demographics
NPI:1821633512
Name:BABY2TEENS PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:BABY2TEENS PEDIATRIC DENTISTRY PLLC
Other - Org Name:BABY2TEENS PEDIATRIC DENTISTRY PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ CHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-228-9200
Mailing Address - Street 1:11319 TYRELL CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-1766
Mailing Address - Country:US
Mailing Address - Phone:860-707-0646
Mailing Address - Fax:
Practice Address - Street 1:221 PARK HILL DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3361
Practice Address - Country:US
Practice Address - Phone:540-228-9200
Practice Address - Fax:540-228-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-17
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty