Provider Demographics
NPI:1811499080
Name:CRUZ ALZATE, JUAN CARLOS (DDS)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:CRUZ ALZATE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 WASHINGTON ST NW
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3542
Mailing Address - Country:US
Mailing Address - Phone:770-534-6933
Mailing Address - Fax:
Practice Address - Street 1:950 WASHINGTON ST NW
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3542
Practice Address - Country:US
Practice Address - Phone:770-534-6933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015569122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist