Provider Demographics
NPI:1003659251
Name:CRUZ, ALEX EDGARDO (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:EDGARDO
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 1:261 BELVOIR HWY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-8193
Mailing Address - Country:US
Mailing Address - Phone:252-747-8162
Mailing Address - Fax:252-747-8163
Practice Address - Street 1:261 BELVOIR HWY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8193
Practice Address - Country:US
Practice Address - Phone:252-747-8162
Practice Address - Fax:252-747-8163
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC138321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice