Provider Demographics
NPI:1396781662
Name:CRUZ, MARIA ELENA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ELENA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 CALLE WILSON
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-2357
Mailing Address - Country:US
Mailing Address - Phone:787-728-6165
Mailing Address - Fax:787-728-4974
Practice Address - Street 1:1475 CALLE WILSON
Practice Address - Street 2:SUITE 1-A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-2357
Practice Address - Country:US
Practice Address - Phone:787-728-6165
Practice Address - Fax:787-728-4974
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice