Provider Demographics
NPI:1144006735
Name:MIGUEL CRUZ, PEDRO (DMD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:
Last Name:MIGUEL CRUZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:PEDRO
Other - Middle Name:ANTONIO
Other - Last Name:MIGUEL CRUZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:5550 S UNIVERSITY DR APT 7305
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5340
Mailing Address - Country:US
Mailing Address - Phone:786-720-5365
Mailing Address - Fax:
Practice Address - Street 1:5550 S UNIVERSITY DR APT 7305
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-5340
Practice Address - Country:US
Practice Address - Phone:786-720-5365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2278E1000X, 390200000X
FLDN29416122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No2278E1000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedEducational
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program