Provider Demographics
NPI:1104717859
Name:QUINTANA CRUZ, ANGEL E SR (DMD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:E
Last Name:QUINTANA CRUZ
Suffix:SR
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 1:2-26 CALLE 5
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-2934
Mailing Address - Country:US
Mailing Address - Phone:787-518-0816
Mailing Address - Fax:
Practice Address - Street 1:PARQUE INDUSTRIAL L-238-0-61 CARRETERA PR-725 KM 05
Practice Address - Street 2:BARRIO LLANOS
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-518-0816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-11
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR35751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice