Provider Demographics
NPI:1205998796
Name:CRUZ, CESAR O (DDS)
Entity type:Individual
Prefix:DR
First Name:CESAR
Middle Name:O
Last Name:CRUZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:CESAR
Other - Middle Name:O
Other - Last Name:CRUZ-ZAMORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:8014 35TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-4815
Mailing Address - Country:US
Mailing Address - Phone:714-313-8864
Mailing Address - Fax:206-525-4469
Practice Address - Street 1:8014 35TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4815
Practice Address - Country:US
Practice Address - Phone:714-313-8864
Practice Address - Fax:206-525-4469
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR35291223G0001X
CA581361223G0001X
WADE602312801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE60231280OtherDENTAL LICENSE